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[目的]观察后路小切口分期延长联合终末矫形内固定融合术治疗小儿脊柱侧凸的临床疗效和安全性。[方法]2007年3月~2015年5月共16例小儿脊柱侧凸在本院接受后路小切口多次分期延长并全部完成终末矫形融合手术。其中先天性10例,早发型5例,神经纤维瘤病1例。对所有病例的临床数据和影像学资料进行回顾性研究,分析手术前后主侧弯角度变化、后凸角度变化、身高变化、手术并发症等。[结果]所有病例均顺利完成手术。共53次手术,平均每人3.4次。接受5次手术者4例,4次手术者2例,3次手术者5例,2次手术者5例。术前主侧凸Cobb角为(102.9±27.9)°(52°~145°),后凸Cobb角(89.2±49.2)°(20°~141°),身高(116.8±9.5)cm(98~132 cm)。终末融合后主侧凸Cobb角(36.4±14.2)°(21°~61°),终末侧凸矫形率64.4%。后凸Cobb角(39.0±9.8)°(31°~50°),终末后凸矫形率56.3%。身高(150.7±9.9)cm(132~165 cm),终末身高增加33.9 cm。围手术期发生内固定棒断裂4例次,内固定松动9例次,皮肤感染3例,一过性神经症状6例次,保守治疗均好转。[结论]后路小切口分期延长联合终末矫形融合术安全性好,终末矫形率高,保持身高增长,可以有效治疗小儿脊柱侧凸。
[Objective] To observe the clinical effect and safety of small incision extended staging combined with end-sleeve orthopedic fusion in the treatment of pediatric scoliosis. [Method] From March 2007 to May 2015, a total of 16 pediatric scoliosis patients underwent multiple posterior small incision extension and all completed the final orthopedic fusion surgery. Of which 10 cases of congenital, early-onset in 5 cases, neurofibromatosis in 1 case. The clinical data and imaging data of all the cases were retrospectively studied. The changes of the main angle before and after surgery, the change of kyphosis angle, the change of height and the complications of operation were analyzed. [Results] All patients completed the operation smoothly. A total of 53 operations, an average of 3.4 times per person. 4 patients underwent 5 surgeries, 2 under 4 surgeries, 5 underwent 3 surgeries and 5 under 2 surgeries. The preoperative Cobb angle was (102.9 ± 27.9) ° (52 ° ~145 °), the Cobb angle was (89.2 ± 49.2) ° (20 ° ~141 °) and 116.8 ± 9.5 cm (98 ~ 132 cm). Cobb angle (36.4 ± 14.2) ° (21 ° ~ 61 °) of the main fusion after terminal fusion, and 64.4% correction of terminal scoliosis. Kyphotic Cobb angle (39.0 ± 9.8) ° (31 ° ~ 50 °), terminal kyphosis correction rate of 56.3%. Height (150.7 ± 9.9) cm (132 ~ 165 cm), terminal height increased by 33.9 cm. Perioperative fracture of internal fixation rod occurred in 4 cases, 9 cases of internal fixation loosening, skin infections in 3 cases, a transient neurological symptoms in 6 cases, conservative treatment were improved. [Conclusion] The posterior small incision prolongation combined with end-to-end orthopedic fusion has good safety, high end-to-end orthopedic rate, maintaining height growth, which can effectively treat pediatric scoliosis.