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目的:探讨术中实时三维影像脊柱导航引导下后路椎弓根螺钉置入及半椎体切除矫治儿童先天性脊柱侧后凸畸形的临床疗效。方法:自2010年5月~2013年4月,对18例儿童先天性半椎体脊柱侧后凸畸形患者进行术中实时三维影像脊柱导航引导下进行脊柱矫形手术。其中,男7例,女11例,年龄7.6±2.9岁。术中在实时三维影像脊柱导航引导下经后路置入椎弓根螺钉并切除半椎体后进行矫形。术后通过CT评价椎弓根螺钉位置及半椎体切除情况,术前、术后摄脊柱正侧位X线片,评价矫形效果。结果:手术时间216±55min,术中出血量732±378ml。18例患者共置入椎弓根螺钉127枚(4~12枚/例)。术后CT证实124枚椎弓根螺钉位置准确,置钉准确率97.6%;1枚椎弓根螺钉穿破椎弓根内侧皮质,2枚椎弓根螺钉穿破椎弓根外侧皮质。1例出现椎弓根螺钉切割,1例出现血气胸,置入胸腔闭式引流。无神经损伤并发症病例,无螺钉误置而引起的并发症。术后CT证实18例患者半椎体均完整切除。18例中有16例获得随访,随访时间18.5±8.0个月。16例术前测量冠状面节段性侧凸Cobb角44.5°±11.4°,术后为9.3°±4.7°,末次随访时为9.7°±5.0°,矫正率为(78.2±7.8)%。节段性后凸Cobb角术前测量为32.2°±7.3°,术后为7.2°±3.5°,末次随访节时为7.7°±3.9°,矫正率为(76±9.4)%。侧凸及后凸矫正与术前相比均有统计学意义(P<0.01)。末次随访时16例患者均获得骨性融合。结论:术中实时三维影像脊柱导航引导经后路矫治先天性脊柱侧后凸畸形半椎体切除完整,置入椎弓根螺钉准确率高,安全性高,畸形矫正效果满意。
Objective: To explore the clinical effect of posterior pedicle screw placement and hemivertebra resection on congenital kyphotic deformity in children under the guidance of real-time three-dimensional video spinal navigation. Methods: From May 2010 to April 2013, 18 cases of children with congenital hemivertebra kyphoscoliosis were treated with real-time three-dimensional video-guided spinal navigation. Among them, 7 males and 11 females, aged 7.6 ± 2.9 years. During operation, pedicle screw was placed in posterior approach guided by real-time three-dimensional image spinal navigation and orthopedic was performed after excision of half vertebral body. Postoperative CT evaluation of pedicle screw position and hemivertebra resection, preoperative and postoperative posterior spinal X-ray film to evaluate the orthopedic effect. Results: The operation time was 216 ± 55min and the blood loss was 732 ± 378ml. Eighteen patients had 127 pedicle screws (4 to 12 cases per case). Postoperative CT confirmed that 124 pedicle screws were correctly positioned and the accuracy of nail placement was 97.6%. One pedicle screw penetrated the medial cortex of the pedicle and two pedicle screws penetrated the lateral cortex of the pedicle. Pedicle screw incision occurred in 1 case, pneumothorax in 1 case and closed thoracic drainage. No complications of neurological injury, no screw misuse caused complications. Postoperative CT confirmed that 18 patients had complete resection of the hemivertebra. Sixteen of 18 patients were followed up for 18.5 ± 8.0 months. In 16 cases, the Cobb angle of coronal segmental scoliosis was 44.5 ° ± 11.4 °, 9.3 ° ± 4.7 ° postoperatively, and 9.7 ° ± 5.0 ° at the final follow-up. The correction rate was (78.2 ± 7.8)%. The preoperative measurement of segmental kyphosis Cobb angle was 32.2 ° ± 7.3 °, postoperatively 7.2 ° ± 3.5 °, the final follow-up was 7.7 ° ± 3.9 °, the correction rate was (76 ± 9.4)%. Scoliosis and kyphosis were statistically significant compared with preoperative (P <0.01). At last follow-up, 16 patients achieved osteosynthesis. Conclusions: Intraoperative real-time three-dimensional image guided spinal navigation guided posterior correction of congenital kyphotic deformity hemivertebra resection complete, pedicle screw placement accuracy, high safety, satisfactory correction of deformity.