植骨及内固定治疗半椎体和重度先天性脊柱侧后凸畸形：三维矫形的有效及安全性

摘要

BACKGROUND:Clinical treatment of hemivertebrae-induced congenital scoliosis is a complex medical problem. OBJECTIVE:To find the optimal treatment for hemivertebrae accompanied by congenital scoliosis. METHODS:Total y 142 hemivertebrae patients who had received surgical treatment in the Department of Orthopedics, the 306 Hospital of Chinese PLA, China from 2010 to 2012 were enrol ed. The main surgical treatment was hemivertebrae resection and bone fusion with internal fixation, apical osteotomy for severe scoliosis and spinal shortening with internal fixation, one-stage posterior thoracolumbar osteotomy with internal fixation, spinal decompression with internal fixation. RESULTS AND CONCLUSION:After treatment, the average correction rate was 70.9%for scoliosis and 71.7%for kyphosis. The fol ow-up period was 14-35 months, with an average of 23.4 months. By the end of the final fol ow-up, the loss rate for Cobb’s angle was 7.3%for scoliosis and 7.7%for kyphosis. Fol ow-up X-ray films showed bone fusion and internal fixation without loosening, fracture, and decompensation. Implementation of one-stage posterior thoracolumbar osteotomy with internal fixation can effectively correct hemivertebrae-induced kyphoscoliosis to obtain a satisfactory spinal sagittal and coronal balance.%背景：由半椎体形成的先天性脊柱侧弯在临床治疗上一直较为复杂。　　目的：寻找治疗半椎体以及半椎体合并极重度先天性脊柱侧弯的最佳方法。　　方法：选择2010至2012年间在解放军306医院骨科进行手术治疗的半椎体畸形患者共142例，手术治疗的方法主要为单纯半椎体切除植骨融合内固定，重度脊柱侧弯顶椎截骨脊柱短缩矫形内固定，一期后路胸腰椎截骨矫形，椎管减压矫形内固定手术。　　结果与结论：治疗后侧凸平均矫正率为70.9%，后凸平均矫正率为71.7%，随访14-35个月，平均23.4个月。末次随访时侧凸Cobb角丢失率为7.3%，后凸Cobb角丢失率为7.7%。随访X射线片证实植骨均融合，内固定物无松动、断裂，未发现失代偿现象。可见施行后路一期截骨固定融合可以有效地矫正半椎体畸形所致的脊柱侧后凸畸形，获得满意的脊柱矢状位、冠状位的平衡。