胸腰椎椎弓根螺钉固定联合半椎体切除术治疗低龄 半椎体先天性脊柱侧弯置钉情况及疗效观察.

Objective To observe the clinical efficacy of thoracic and lumbar pedicle screw fixation combined with hemivertebra resection in the treatment of congenital scoliosis caused by hemivertebra in young children, and to analyze the accuracy of screw placement. Methods Nineteen children with congenital scoliosis due to hemivertebra were enrolled, including 11 males and 8 females, aged 1-9 years. Posterior median approach was adopted for pedicle screw fixation, hemivertebra resection and bone graft fusion. The fixation segment of the pedicle screw was from the 1st thoracic vertebral body to the 5th lumbar vertebral body （T1-L5). During the operation, the pedicle screw was placed by free hand ac‐ cording to the positioning of the C-arm and anatomical landmarks. According to the distance of the pedicle screw penetrating the interior, lateral or anterior sides of the vertebral body （including the pedicle) cortical bone, we graded and recorded the screw placement at each level. Coronal plane parameters （total scoliosis angle, segmental scoliosis angle, cephalic compensatory curve, caudal compensatory curve, apical vertebral offset, and coronal plane balance) and sagittal plane parameters （thoracic kyphosis, lumbar lordosis, segmental kyphosis, and sagittal plane balance) were used to evaluate clini‐ cal efficacy, and we recorded intraoperative or postoperative complications related to pedicle screw placement. Results The operation time of children in this group was （253±55) min, and the blood loss was （239±85) mL. Single hemivertebra was removed in 9 cases, and 2 hemivertebra were removed in 2 cases. A total of 120 pedicle screws were placed, 103 screws were correctly placed （85. 8%), and 17 screws were abnormally placed （14. 2%). The rate of abnormal screw placement in the thoracic region was higher than that in the lumbar region （P<0. 01). The coronal total scoliosis angle, segmental scoliosis angle, cephalic compensatory curve, caudal compensatory curve and sagittal plane segmental kyphosis were lower than those before operation （all P<0. 01). The immediate correction rates were 78. 8%, 76. 6%, 62. 9%, 71. 7%, and 68. 2%, respectively. During the follow-up, a small amount was lost, and the cephalic compensatory curve was corrected by 0. 2°±1. 0°； postoperative apical vertebral offset, coronal plane balance, and sagittal plane balance were smaller than those before operation （all P<0. 01). During the operation and postoperative follow-up, no complications re‐ lated to the nervous system occurred, and no complications related to pedicle screw placement occurred. Conclusions Thoracic and lumbar pedicle screw fixation combined with hemivertebra resection for congenital scoliosis due to hemiverte‐ bra in young children can achieve satisfactory clinical results, and there are fewer postoperative complications related to pedicle screw placement. However, the risk of misplacement of screws in the thoracic region is higher than that in the lum‐ bar region, so attention should be paid to risk prevention and control. [ABSTRACT FROM AUTHOR]