Individualized Study of Posterior Hemivertebra Excision and Short‐Segment Pedicle Screw Fixation for the Treatment of Congenital Scoliosis

摘要

OBJECTIVES:To compare the surgical effect of children with symmetrical screw fixation and asymmetric screw fixation during posterior hemivertebra excision and short-segment pedicle screw fixation for the treatment of congenital scoliosis (CS).METHODS:A total of 30 children with CS who underwent posterior hemivertebra excision and short-segment bilateral pedicle screw fixation in our hospital from 2012 to 2018 were retrospectively included and were divided into two groups: symmetric fixation group (n = 18) and asymmetric fixation group (n = 12). The total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, coronal balance, and apical vertebra translation were measured in the coronal plane. The segmental kyphosis, thoracic kyphosis, lumbar lordosis, and sagittal balance were measured in the sagittal plane.RESULTS:Of the 30 children, 28 hemivertebrae were resected. Twenty-two children had one hemivertebra, three had two hemivertebrae, and five were rib deformities. The average operation time was 268?min (180-420?min). The average blood loss was 291?mL (150-550?mL). The average follow-up was 21.1?months (12-47?months). For symmetric fixation group and there were significant differences among postoperative and follow-up parameters including the total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, apical vertebra translation and segmental kyphosis compared with those of preoperative parameters (P??0.05). There were three complications in 30 children in our study, including two cases who had poor wound healing, and the wound healed smoothly after half a month of sterile dressing change. Postoperative curve progression occurred in one case after T 12 and L 3 hemivertebra resection and thoracic hemivertebra resection was planned again.CONCLUSION:For pedicles which were difficult for screw fixation, adjacent segments can be chosen for screw fixation and it is safe and effective for vertebral pedicles ≤3 without internal fixation.? 2020 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.