大块自体骨原位椎间植骨融合技术在儿童半椎体切除术中的应用研究.

Objective To explore the application of intervertebral autologous bone graft in situ in hemivertebral resection surgery in children. MethodsA retrospective study was conducted for 70 children undergoing single-level hemivertebral resection due to congenital scoliosis. According to different surgical approaches, they were divided into control group and observation group (n=35 each). The control group underwent traditional posterior hemivertebral resection, bone grafting, fusion and internal fixation. The observation group underwent posterior hemivertebral resection, anterior structural reconstruction (massive autologous bone graft in situ for intervertebral fusion) and posterior bone grafting. Clinical data, surgical findings and postoperative follow-ups were recorded. Based upon radiographs of whole spine at the time of pre-operation, post-operation and follow-ups, the relevant sagittal and coronal imaging parameters were measured. Postoperative spinal computed tomography (CT) images were acquired during follow-ups for evaluating the outcomes of bone graft fusion. Results No inter-group statistical difference existed in gender, height, age, weight, hemivertebral distribution, operative duration, intraoperative blood loss or length of hospitalization stay (P>0. 05). Preoperative coronal parameters (major curve Cobb's angle, proximal compensatory curve & distal compensatory curve) or sagittal plane parameters (segmental kyphosis angle, thoracic kyphosis angle, thoracolumbar kyphosis angle, sagittal plane balance & lumbar lordorsis angle) showed no significant difference (P>0. 05). At the last follow-up, loss of major curve Cobb's angle and segmental kyphosis angle were significantly smaller in observation group than those in control group, which had significant differences (P<0. 05); CT scan revealed that the rate of intervertebral fusion (level 1) was higher in observation group with a statistical difference (P<0. 05); no obvious operation-related complications occurred in neither groups. Conclusion In situ intervertebral bone grafting of massive autogenous bone may achieve excellent correction and satisfactory intervertebral fusion through anterior support and reconstruction, which has significant advantages for the correction of lumbar lordosis. At the same time, due to anterior intervertebral support and fusion, it is more benefical to maintain postoperative kyphosis angle and avoid excessive angle loss. [ABSTRACT FROM AUTHOR]