后路半椎体切除短节段融合治疗先天性脊柱侧弯.doc

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1、后路半椎体切除短节段融合治疗先天性脊柱侧弯作者：许伟华，杨述华，杜靖远【摘要】［目的］探讨单纯经后方入路半椎体切除后，行短节段椎弓根螺钉矫形固定对先天性脊柱侧弯的疗效。［方法］21例先天性半椎体畸形的患儿，单纯经后方入路切除半椎体，并一期行后路短节段椎弓根螺钉系统矫形固定和脊柱植骨融合术，比较术前、术后和最后一次随访脊柱全长正侧位X线片，测量并记录脊柱侧弯及后凸的Cobb，s角。［结果］本组病例脊柱畸形明显改善，冠状面，半椎体节段侧弯术前平均41.5。,术后15.1。,矫正率63.6%;最后一次随访时平均14.7。,矫正64.6%;冠状面主侧弯术前平均46.9。,术后

2、18.4°,矫正60.8%;最后一次随访时平均17.5°,矫正62.7%;矢状面，半椎体节段术前有15.4。后凸畸形，术后恢复至正常生理曲度范围。手术后头侧和尾侧代偿弯也得到明显改善。［结论］单纯后方入路切除半椎体后行短节段椎弓根螺钉系统矫形内固定术，可满意地矫正先天性脊柱侧弯，在骨骼成熟之前进行治疗可有效地预防继发性的脊柱改变。【关键词】先天性；脊柱侧弯；半椎体切除；脊柱融合Abstract:[Objective]Toevaluatesurgicaloutcomesofhemivertebraresectiononlyviaposteriorapproachesfo

3、llowedbyshort-segmenttranspedicularinstrumentationforcorrectionofthecongenitalscoliosos・[Method]Agroupofpatientswithasinglehemivertebrabetweentheages5-16yearswhounderwentoperativetreatmentwereevaluated・Hemivertebraresectionthroughposteriorapproachandshort-segmenttranspedicularinstrument

4、ationwereusedforcorrectionofthescoliosisandkyphosisdeformities・Radiographicevaluationwereconductedbeforeandafteroperationandatfollow-upvisits.Cobb'sanglesofthesegmentalcurve,totalmaincurve,cranialandcaudalcompensatorycurvesandkyphosisweremeasuredontheposteroanteriorandlateralradiographs

5、・[Result]Thecasesinthisstudyshowedsatisfiedresults・ThemeanCobb，sangleofsegmentcurvewas41.5°beforesurgeryand15.1°aftersurgerywitha63.6%correction,and14.7°atthelastestfollow-upassessmentwitha64.6%correction;totalmaincurvesimprovedfrom46.9°to18.4°，witha60.8%correction;17.5°atlastfollow-up,

6、witha62.7%correction;thecorrectionratioforkyphosiswasfrom15.4°kyphosistonormalphysicalprofile;cranialandcaudalcompensartorycurveswereobviouslyimproved・[Conclusion]Hemivertebraresectionandshort-segmenttranspedicularinstrumentationcouldbeperformedonlythroughposteriorapproach,whichhadexert

7、edsatisfactorycorrectiononcongenitalscoliosis・Iftheoperationisperformedbeforethematurityofthebone,itwilleffectivelypreventtheformationofsecondlyspinaldeformities・Keywords:congenital;scoliosis;hemivertebraexcision;spinalfusion先天性半稚体由于一侧的椎体发育不良而导致脊柱畸形。按照病理可分为三种类型，完全分节型、部分分节型和封闭分节