不同年龄后路半椎体切除的临床比较△

Comparison of clinical outcomes of posterior hemivertebrotomy in different ages

摘要:

[目的] 比较不同年龄段行后路半椎体切除术治疗单纯半椎体脊柱畸形的临床效果。[方法] 回顾性分析 2013 年 1 月—2020 年 12 月收治的 80 例单纯半椎体脊柱畸形低龄患儿临床资料，按年龄段不同分为幼龄组 43 例，大龄组 37 例，均行后路半椎体切除术治疗。比较两组围手术期、随访及影像资料。[结果]两组患儿均顺利完成手术，术中无神经、血管损伤等并发症。幼龄组手术时间、术中出血量、固定节段均显著少于大龄组 (P＜0.05)。两组患者均获随访，随访时间 10~12 个月， 平均(11.05±0.84)个月。随时间推移，两组坐高、身高均较术前显著增加(P＜0.05)，两组下地活动时间、完全负重时间、坐高变化率和并发症发生率的差异均无统计学意义(P＞0.05)。 影像方面，与术前相比较，术后即刻和末次随访时两组后凸 Cobb 角、侧凸 Cobb 角和 C7PL-CSVL 均显著减小(P＜0.05)。相应时间点，幼龄组的后凸 Cobb 角、侧凸 Cobb 和 C7PL-CSVL 显著小于大龄组 (P＜0.05)。两组术后即刻、末次随访的后凸、侧凸 Cobb 角矫正率与 C7PL-CSVL 矫正率的差异均无统计学意义 (P＞ 0.05)。经 Pearson 相关分析发现：年龄与手术时间、失血量呈正相关(P＜0.001)，与坐高变化率、后凸 Cobb 角、侧凸 Cobb 角和 C7PL 的矫正率无相关性 (P＞0.05)。[结论] 早期对单纯半椎体脊柱畸形低龄患儿行后路半椎体切除术可缩短手术时间，减少术中出血量与固定节段。

Abstract:

[Objective] To compare the clinical results of posterior hemivertebrotomy for treatment of spinal deformities due to single hemivertebra in different ages. [Methods] A retrospective study was performed on 80 children who underwent posterior hemivertebrotomy for spinal deformities due to single hemivertebra in our department from January 2013 to December 2020. Based on the age at operation, 43 children who aged 3 to 6 years were fall into the young group, while 37 children who aged more than 6 to 10 years were enrolled into the old group. The perioperative, follow- up and radiographic documents were compared between the two groups. [Results] All children in both groups had the surgical procedures completed smoothly without complications, such as nerve and vascular injury. The young group con- sumed significantly shorter operative time, associated with significantly less intraoperative blood loss and segments fixed than the old group (P＜0.05) . Patients in both groups were followed up for 10~12 months, with an average of (11.05±0.84) months. The sitting height and stand- ing height significantly increased in both groups over time (P＜0.05) , while there were no significant differences in the time to resume walk- ing and full weight-bearing activity, the variation rate of sitting height and the incidence of complications between the 2 groups (P＞0.05) . Radiographically, kyphotic Cobb angle, scoliotic Cobb angle, and C₇PL-CSVL were significantly reduced in both groups immediately after surgery and at the last follow-up compared with those preoperatively (P＜0.05) . At corresponding time points, they young group had signifi- cantly less kyphotic Cobb angle, scoliotic Cobb angle and C7PL-CSVL than the old group (P＜0.05) . There was no statistical significance in the correction rate of kyphotic and scoliotic Cobb angles and the correction rate of C₇PL-CSVL between the two groups immediately after surgery and at the last follow-up (P＞0.05) . Pearson correlation analysis found that age was positively correlated with operating time and blood loss (P＜0.001) , but not correlated with sitting height change rate, kyphotic Cobb angle, scoliotic Cobb angle, and C₇PL correction rate (P＞0.05) . [Conclusion] Early posterior hemivertebrotomy for spinal deformities due to single hemivertebra might be conducive to shorten the operation time, reduce intraoperative blood loss and fixed segments.