目的 探讨小儿先天性半椎体畸形行后路半椎体切除单侧短节段固定术的长期疗效。 方法 病例系列报告。纳入2000年1月—2018年1月山西医科大学第二医院骨科先天性半椎体畸形患儿26例，其中男12例、女14例，年龄2~12（5.4±2.9）岁。26例患儿半椎体畸形均为单发，其中完全分节型17例、半分节型9例，均采用后路半椎体切除单侧短节段固定术治疗。观察指标：（1）统计手术时间、术中出血量，以及术后感染、神经功能损伤等并发症发生情况。（2）统计术后即刻侧凸Cobb角、局部后凸角的矫正率，比较患者术前、术后即刻、术后6个月、术后1年、术后5年5个不同时间点间侧凸Cobb角、矢状面轴向距离（SVA）、胸椎后凸角（TK）、局部后凸角，用以评估矫形效果；（3）比较患者术前和术后1~5年近端椎体和远端椎体的凸侧高度、凹侧高度、双侧椎弓根投影外侧缘距离（BLPD）；统计术后5年各项指标的总增长率。 结果 （1）26例手术均顺利完成，无围术期死亡病例。手术时间84~174（120.0±24.0）min，术中出血75~130（100.0±16.1）mL。患者术后即刻侧凸Cobb 角矫正率为66.3%±18.4%，局部后凸角矫正率为47.7%±40.4%。术后切口愈合良好，无感染、神经损伤等并发症发生情况。（2）26例患者均获随访，随访时间60~82（68.8±8.1）个月。术前、术后即刻、术后6个月、术后1年、术后5年，患者侧凸Cobb角分别为36.3°±11.4°、12.3°±7.4°、12.1°±7.4°、12.1°±7.5°、12.6°±7.4°，SVA分别为2.1°±1.1°、2.2°±0.9°、2.3°±1.0°、2.4°±0.9°、2.3°±1.2°，TK分别为26.1°±9.2°、23.4°±8.1°、23.6°±8.1°、23.9°±8.0°、28.5°±8.9°，局部后凸角分别为21.8°±10.1°、9.8°±6.0°、9.7°±5.8°、9.8°±6.2°、9.7°±5.3°。术后即刻、6个月、1年，患者侧凸Cobb角、TK、局部后凸角均小于术前，术后5年侧凸Cobb角、局部后凸角小于术前，差异均有统计学意义（P值均<0.05）；不同时间点间SVA比较，以及术后5年TK与术前比较，差异均无统计学意义（P值均>0.05）。（3）26例患者术后1～5年近端椎体和远端椎体的凸侧高度、凹侧高度、BLPD与术前比较，均呈增加趋势，差异均有统计学意义（F近端=76.12、34.80、13.27，F远端=108.13、59.94、20.40，P值均<0.001）。术后5年近端椎体和远端椎体的凸侧高度总增长率分别为106.4%±89.3%和96.9%±74.1%，凹侧高度总增长率分别为91.0%±93.5%和96.2%±101.3%，BLPD总增长率分别为37.0%±47.7%和40.4%±70.3%。 结论 后路半椎体切除并单侧短节段固定融合术治疗小儿先天性半椎体畸形可取得满意的矫形效果，术后5年随访矫正效果维持良好。 Objective This study aimed to investigate the long-term efficacy of posterior hemilaminectomy with unilateral short-segment fixation in pediatric congenital hemivertebra malformations. Methods This was a series case report. Clinical data of 26 children with congenital hemivertebra malformations admitted to the Department of Orthopedics of the Second Hospital of Shanxi Medical University from January 2000 to January 2018, were included. The patients consisted of 12 males and 14 females, aged 2-12 (5.4±2.9) years. The hemivertebra malformations were all single, including 17 cases of complete segmental type and nine cases of hemi-segmental type. The children were treated with posterior hemilaminectomy with unilateral short-segment fixation. Observation indicators: (1) The duration of the operation the amount of intraoperative bleeding and the occurrence of postoperative complications, such as infection and nerve damage, were analyzed. (2) The scoliosis Cobb angle, sagittal axial distance (SVA), thoracic kyphosis (TK) angle, and local kyphosis angle before surgery immediately after surgery and 6 months, 1 year, and 5 years after surgery were compared to evaluate the orthopedic effect. The correction rates of the immediate postoperative lateral convex Cobb angle and localized posterior convex angle were compared. (3) The convex and concave heights of proximal vertebral bodies (PVB)and distal vertebral bodies (DVB) and the bilateral pedicle distance (BLPD) were compared before and 1-5 years after surgery. The total growth rate of each index in 5 years after the operation was analyzed. Results (1) All 26 surgeries were successfully completed with no perioperative deaths. The duration of surgery ranged from 84 min to 174 (120.0±24.0) min. The intraoperative bleeding was 75-130 (100.0±16.1) mL. The immediate postoperative scoliosis Cobb angle correction rate was 66.3%±18.4%. The localized posterior convexity correction rate was 47.7%±40.4%. The postoperative incision healed well without complications such as infection and nerve damage. (2) All 26 patients were followed up for 60-82 (68.8±8.1) months. The preoperative, immediate postoperative, 6-month postoperative, 1-year postoperative, and 5-year postoperative Cobb angles of lateral convexity were 36.3°±11.4°, 12.3°±7.4°, 12.1°±7.4°, 12.1°±7.5°, and 12.6°±7.4°, respectively, and SVAs were 2.1°±1.1°, 2.2°±0.9°, 2.3°±1.0°, 2.4°±0.9°, and 2.3°±1.2°, respectively the TK angles were 26.1°±9.2°, 23.4°±8.1°, 23.6°±8.1°, 23.9°±8.0°, and 28.5°±8.9°, respectively and the localized posterior convexity angles were 21.8°±10.1°, 9.8°±6.0°, 9.7°±5.8°, 9.8°±6.2°, and 9.7°±5.3°, respectively. The immediate postoperative and 6-month and 1-year postoperative lateral convex Cobb angle, TK angle, and localized posterior convexity angle of the patients were smaller than those at pre-operation, and the lateral convexity Cobb angle and localized posterior convexity angle were less than those at pre-operation and 5 years post-operation. The differences were statistically significant (all P values <0.05). The differences of the SVA at different postoperative time points and TK angle at 5 years post-operation compared with those at pre-operation were statistically significant (all P values >0.05). (3) The convex lateral height, concave lateral height, and BLPD of the PVB and DVB in 26 patients showed an increasing trend from 1 year to 5 years after surgery compared with the preoperative period. The differences were statistically significant ( F PVB = 76.12, 34.80, 13.27 and F DVB = 108.13, 59.94, 20.40, all P values <0.001). The convex lateral height total growth rates of the PVB and DVB at 5 years after surgery were 106.4%±89.3% and 96.9%±74.1%, respectively the total growth rates of concave lateral height were 91.0%±93.5% and 96.2%±101.3%, respectively the BLPD total growth rates were 37.0%±47.7% and 40.4%±70.3%, respectively. Conclusion The posterior hemivertebra resection with unilateral short-segment fixation and fusion for the treatment of congenital hemivertebra deformity in pediatric patients can achieve satisfactory orthopedic results. The correction is well maintained at 5-year follow-up, making it a safe and effective treatment for this type of deformity.
Long-term efficacy of pediatric congenital hemivertebra deformity after posterior hemivertebrectomy with unilateral short-segment fixation
Objective This study aimed to investigate the long-term efficacy of posterior hemilaminectomy with unilateral short-segment fixation in pediatric congenital hemivertebra malformations. Methods This was a series case report. Clinical data of 26 children with congenital hemivertebra malformations admitted to the Department of Orthopedics of the Second Hospital of Shanxi Medical University from January 2000 to January 2018, were included. The patients consisted of 12 males and 14 females, aged 2-12 (5.4±2.9) years. The hemivertebra malformations were all single, including 17 cases of complete segmental type and nine cases of hemi-segmental type. The children were treated with posterior hemilaminectomy with unilateral short-segment fixation. Observation indicators: (1) The duration of the operation the amount of intraoperative bleeding and the occurrence of postoperative complications, such as infection and nerve damage, were analyzed. (2) The scoliosis Cobb angle, sagittal axial distance (SVA), thoracic kyphosis (TK) angle, and local kyphosis angle before surgery immediately after surgery and 6 months, 1 year, and 5 years after surgery were compared to evaluate the orthopedic effect. The correction rates of the immediate postoperative lateral convex Cobb angle and localized posterior convex angle were compared. (3) The convex and concave heights of proximal vertebral bodies (PVB)and distal vertebral bodies (DVB) and the bilateral pedicle distance (BLPD) were compared before and 1-5 years after surgery. The total growth rate of each index in 5 years after the operation was analyzed. Results (1) All 26 surgeries were successfully completed with no perioperative deaths. The duration of surgery ranged from 84 min to 174 (120.0±24.0) min. The intraoperative bleeding was 75-130 (100.0±16.1) mL. The immediate postoperative scoliosis Cobb angle correction rate was 66.3%±18.4%. The localized posterior convexity correction rate was 47.7%±40.4%. The postoperative incision healed well without complications such as infection and nerve damage. (2) All 26 patients were followed up for 60-82 (68.8±8.1) months. The preoperative, immediate postoperative, 6-month postoperative, 1-year postoperative, and 5-year postoperative Cobb angles of lateral convexity were 36.3°±11.4°, 12.3°±7.4°, 12.1°±7.4°, 12.1°±7.5°, and 12.6°±7.4°, respectively, and SVAs were 2.1°±1.1°, 2.2°±0.9°, 2.3°±1.0°, 2.4°±0.9°, and 2.3°±1.2°, respectively the TK angles were 26.1°±9.2°, 23.4°±8.1°, 23.6°±8.1°, 23.9°±8.0°, and 28.5°±8.9°, respectively and the localized posterior convexity angles were 21.8°±10.1°, 9.8°±6.0°, 9.7°±5.8°, 9.8°±6.2°, and 9.7°±5.3°, respectively. The immediate postoperative and 6-month and 1-year postoperative lateral convex Cobb angle, TK angle, and localized posterior convexity angle of the patients were smaller than those at pre-operation, and the lateral convexity Cobb angle and localized posterior convexity angle were less than those at pre-operation and 5 years post-operation. The differences were statistically significant (all P values <0.05). The differences of the SVA at different postoperative time points and TK angle at 5 years post-operation compared with those at pre-operation were statistically significant (all P values >0.05). (3) The convex lateral height, concave lateral height, and BLPD of the PVB and DVB in 26 patients showed an increasing trend from 1 year to 5 years after surgery compared with the preoperative period. The differences were statistically significant ( F PVB = 76.12, 34.80, 13.27 and F DVB = 108.13, 59.94, 20.40, all P values <0.001). The convex lateral height total growth rates of the PVB and DVB at 5 years after surgery were 106.4%±89.3% and 96.9%±74.1%, respectively the total growth rates of concave lateral height were 91.0%±93.5% and 96.2%±101.3%, respectively the BLPD total growth rates were 37.0%±47.7% and 40.4%±70.3%, respectively. Conclusion The posterior hemivertebra resection with unilateral short-segment fixation and fusion for the treatment of congenital hemivertebra deformity in pediatric patients can achieve satisfactory orthopedic results. The correction is well maintained at 5-year follow-up, making it a safe and effective treatment for this type of deformity.
万方数据
