Analysis on operative effect of posterior instrumentation and fusion for the surgical treatment of congenital kyphoscoliosis / 中国矫形外科杂志

ABSTRACT

[Objective]To evaluate the surgical effect of posterior correction and instrumentation on the treatment of congenital kyphoscolosis deformity. [Methods]From july 2002 to august 2007,there were 15 congenital kyphoscoliotic patients,which included 8 males and 7 females with an average age of 11.6 years.The average Cobb’s angle of scoliosis was 78?(35?~156?),the average Cobb’s angle of kyphosis was 25?(15?~38?).For the 9 kyphoscolsis patients with hemivertebra,hemivertebra resection and intervertebral fusion and fixation with pedicle screw instrument system were used,Luque’s systems was used in 2 cases,for the 3 cases accompanied with Chiari malformation and/or syringomyelia and 1 case with neurofibroma,posterior correction and long segmental pedicle screw fixation were performed and the compensative curve was included in the instrumentation level.[Results]The operation time was 3.5~7.5 h (average,5.5 h ),the blood loss was 300~2 100 ml (mean,850 ml);the average follow-up was 43 months (10~82 months),and the radiographs taken from standing posteroanterior position and lateral side showed that the mean Cobb’s angle of scoliosis was corrected from preoperative 78? to postoperative 28?(11?~38?),with a correction rate of 64%.Postoperatively ,the angle of kyphosis was improved from the preoperative 25? to 16?( 7?~33?),with a correction rate of 36%.Solid fusion was achieved in all 15 cases of patients. But significant blood loss occurred in the operative procedure of neurofibroma. And long term follow-up showed 3 cases of rod fracture,1 case of crankshaft phenomenon.[Conclusion]The congenital kyphoscolosis deformity is a kind of complex syndrome concerning skeleton-muscle-nerve system,aim to different cause,strategy of treatment should be individualized.The posterior hemivertebral resection and correction is a safe and effective method for the prepubertal children with the congenital hemivertebrae deformity.