夏三强,刘 盾,石 博,李 洋,史本龙,刘 臻,邱 勇,朱泽章.伴无症状性椎管内异常的先天性脊柱侧凸患儿半椎体切除术疗效及安全性评估[J].中国脊柱脊髓杂志,2018,(12):1095-1100.
伴无症状性椎管内异常的先天性脊柱侧凸患儿半椎体切除术疗效及安全性评估
中文关键词:  先天性畸形  脊髓拴系  脊髓纵裂  脊髓空洞  神经并发症
中文摘要:
  【摘要】 目的:分析伴无症状性椎管内异常的先天性脊柱侧凸患儿行半椎体切除术的临床疗效,评估半椎体切除术治疗该类患儿的有效性及安全性。方法:回顾性分析2012年1月~2017年4月在我院行半椎体切除手术的先天性脊柱侧凸患儿的病例资料,共纳入36例(男15例,女21例),平均年龄6.6±2.7(2~9)岁。患儿术前全脊柱MRI发现椎管内脊髓拴系、脊髓纵裂及脊髓空洞,经详细的神经查体无神经系统异常。于术前、术后1周和末次随访时的站立位全脊柱正侧位X线片上测量侧凸Cobb角、冠状面平衡(C7PL-CSVL)、后凸Cobb角和矢状面平衡(SVA)等参数;记录患儿术中、术后及随访过程中的并发症。结果:患儿侧凸Cobb角术前为37.7°±16.4°,术后1周为10.4°±9.2°,手术平均矫正率为(72.4±27.9)%,有统计学差异(P<0.001);后凸Cobb角术前为20.3°±5.4°,术后1周为1.6°±3.4°,有统计学差异(P<0.001)。术前、术后C7PL-CSVL分别为10.6±5.4mm、7.9±5.3mm,SVA分别为-6.4±19.8mm、1.2±14.1mm,无统计学差异(P>0.05)。术后平均随访46.1±20.3(12~72)个月,末次随访时侧凸Cobb角、后凸Cobb角、C7PL-CSVL和SVA分别为11.3°±13.7°、3.1°±7.2°、9.1±4.8mm和8.7±22.4mm,无明显矫正丢失(P>0.05)。1例患儿术中出现硬脊膜破裂、脑脊液漏,修补后愈合良好。1例患儿术后出现继发弯加重>5°,3例患儿出现近端交界性后凸,均经过支具保守治疗后控制良好。所有患儿术后及随访中均未见神经系统相关并发症及内固定失败并发症。结论:无神经损害表现的伴椎管内异常的先天性脊柱侧凸患儿行半椎体切除术可以有效地矫正脊柱畸形,不明显增加术中及术后发生神经并发症的风险。
Efficiency and safety of hemi vertebra resection for congenital scoliosis children coexisting asymptomatic intraspinal anomalies
英文关键词:Congenital scoliosis  Tethered cord  Split cord malformation  Syringomyelia  Neurological complication
英文摘要:
  【Abstract】 Objectives: To evaluate the efficiency and safety of hemivertebra resection in the treatment of children with congenital scoliosis coexisting asymptomatic intraspinal anomalies. Methods: Congenital scoliosis patients coexisting asymptomatic intraspinal anomalies who underwent hemivertebra resection from January 2012 to April 2017 were retrospectively reviewed. A total of 36 patients (15 males and 21 females) with a mean age of 6.6±2.7(2-9) years were included. The intraspinal anomalies were revealed by MRI including tethered cord, split cord malformation and syringomyelia. No obvious neurological symptoms were found in preoperative physical examination. On standing whole spinal X-rays at pre-operation, 1 week post-operation and the final follow-up, the Cobb angle, the distance between C7 plumb line and center sacral vertical line(C7PL-CSVL), the local kyphosis, and the sagittal vertical axis(SVA) were measured. The complications during surgery and follow-up were recorded. Results: The average Cobb angle was 37.7°±16.4° at pre-operation and 10.4°±9.2° at 1 week post-operation(P<0.001). The average correction rate was (72.4±27.9)% (P<0.001). The average local kyphosis was 20.3°±5.4° at pre-operation and 1.6°±3.4° at post-operation(P<0.001). The pre-operational and 1 week post-operational values were 10.6±5.4mm and 7.9±5.3mm for C7PL-CSVL, -6.4±19.8mm and 1.2±14.1mm for SVA. No significant difference was found between pre-operational and 1 week post-operation(P>0.05). The mean follow-up period was 46.1±20.3(12-72) months. Cobb angle, local kyphosis, C7PL-CSVL and SVA at the final follow-up were 11.3°±13.7°, 3.1°±7.2°, 9.1±4.8mm and 8.7±22.4mm, respectively. No significant correction loss was found during follow-up(P>0.05). Cerebrospinal fluid leakage occurred in one patient during surgery, who recovered after conservative treatment. The compensatory curve progressed more than 5° occurred in one patient and proximal junctional kyphosis occurred in 3 patients, which were well controlled after bracing treatment. There was no implant failure or neurological complication. Conclusions: The clinical outcomes of hemi-vertebra resection for congenital scoliosis coexisting asymptomatic intraspinal anomalies are satisfying, with the risks of neurological complications not significantly increasing.
投稿时间:2018-07-07  修订日期:2018-10-26
DOI:
基金项目:江苏省博士后科研资助计划(1701018C);江苏省自然科学基金青年基金(BK20170126);中国博士后科学基金面上资助(2017M610323)
作者单位
夏三强 南京医科大学鼓楼临床医学院脊柱外科 210008 南京市 
刘 盾 南京医科大学鼓楼临床医学院脊柱外科 210008 南京市 
石 博 南京医科大学鼓楼临床医学院脊柱外科 210008 南京市 
李 洋  
史本龙  
刘 臻  
邱 勇  
朱泽章  
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