目的 评估单一后路经椎弓根半椎体全切除术治疗儿童半椎体畸形的效果.方法 回顾性分析2005年7月至2006年6月采用单一后路经椎弓根半椎体全切除术治疗的27例儿童先天性脊柱侧凸患者的临床资料.其中男性16例,女性11例;年龄1.3～10.0岁,平均5.5岁.半椎体位于胸椎12例,位于腰椎15例.术前术后及随访时均摄全脊柱站立位正侧位X线片,评价术后矫形效果及随访失代偿情况.结果 手术时间3-6 h,平均4 h;术中出血300～2200 ml,平均750 ml.固定节段2～7个椎体,平均4.4个椎体.随访12-34个月,平均16个月.主弯Cobb角均值术前40.0°,术后12.6°,末次随访15.2°.局部侧凸Cobb角均值术前35.6°,术后11.6°,末次随访12.1°.顶椎偏移均值术前16.5 mm,术后7.5 mm,末次随访7.6 mm.半椎体位于胸椎者局部后凸Cobb角均值术前26.4°,术后14.6°,末次随访15.5°.半椎体位于腰椎者局部后凸Cobb角均值术前11.2°,术后3.9°,末次随访4.8°.围手术期并发症包括2例(各1枚)椎弓根螺钉位置不良需翻修和1例术后骨盆倾斜者,无术后神经损害病例.结论 单一后路经椎弓根半椎体伞切除术可同时矫正冠状位和矢状位畸形,近期随访无丢失.并且此手术适用于儿童中胸、下胸、腰段半椎体畸形患者.%Objective To evaluate the early outcomes of children with congenital scoliosis treated by one-stage transpedicular hemivertebra resection. Methods From July 2005 to June 2006, 27 consecutive cases of congenital scoliosis managed by one-stage transpedicular hemivertebra resection with instrumentation were investigated retrospectively. There were 11 girls and 16 boys, with a mean age of 5. 5 years at surgery (range 1.3-10.0 years). Location of the hemivertebra was in the thoracic spine in 12 cases and in the lumbar spine in 15 cases. Radiographic evaluations were performed on the preoperative, postoperative, and latest follow-up standing posteroanterior and lateral radiographs. Results The average operation time was 4 hours (range 3-6 hours), and the mean blood loss during operation was 750 ml (range 300-2200 ml). The mean fusion level was 2 to 7 segments, average 4. 4 segments. The average follow-up period was 16 months (range 12-34 months). Mean Cobb angle of the total main curve was 40.0° before surgery, 12. 6° after surgery, and 15. 2° at latest follow-up. Mean Cobb angle of the segmental main curve was 35. 6° before surgery, 11.6° after surgery, and 12. 1° at latest follow-up. The trunk shift was improved from 16. 5 mm before operation to that of 7. 5 mm after the operation and 7. 6 mm at the latest follow-up. Compensatory cranial curve improved from 19.4° before surgery to 8.9° after surgery, and compensatory caudal curve improved from 26. 3° to 12. 8°. The angle of segmental kyphosis was 26.4° before surgery and 14. 6° after surgery in cases with thorcic hemivertebrae, and averaged 11. 2° before surgery and 3. 9° after surgery in cases with lumbar hemivertebrae. Peri-operative complications included two pedicle screws malpositioning and one case with pelvic tilt. There was no neurological complication. Conclusion One-stage transpedicular hemivertebra resection with instrumentation has a good capability of correcting deformity on the frontal and sagittal planes, which is available in children with middle or lower thoracic or lumbar hemivertebrae.
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