Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2008; 75(3):180-184 | DOI: 10.55095/achot2008/035

Prostá kostěná fúze versus instrumentovaná hemivertebrektomie v operační léčbě kongenitálních skoliózPůvodní práce

M. REPKO¹, M.KRBEC¹, J. BURDA¹, J. PEŠEK¹, R. CHALOUPKA¹, V. TICHݹ, J. NEUBAUER²

¹ Ortopedická klinika LF MU a FN Brno-Bohunice, Univerzitní centrum pro léčbu skolióz a deformit páteře, Brno-Bohunice

² Radiologická klinika LF MU a FN Brno-Bohunice

PURPOSE OF THE STUDY:
In a retrospective study, to analyze long-term radiographic results of two surgical procedures used to treat congenital scoliosis.

MATERIAL AND METHODS:
A total of 685 patients with congenital scoliosis were treated at the Department of Orthopaedic Surgery, Bohunice Teaching Hospital in Brno, between 1976 and 2007. Of these, 102 patients, with an average age of 6.6 years at the time of surgery, were treated by simple bony fusion, and 22 children, with an average age of 10.2 years, underwent instrumented hemivertebra excision via simultaneous anterior and posterior exposures involving fixation with cannulated compression screws and a wire loop. The follow-up periods for the former and latter groups were 14.2 and 12.1 years, respectively.

RESULTS:
In the patients treated by simple bony fusion, the mean correction rate was 22.1 %, with Cobb angle values averaging from 44.2° pre-operatively to 38° post-operatively; the correction loss was 3.9° at the last follow up. In the patients with hemivertebra excision, the mean correction rate was 61 %, with pre- and post-operative values of 51.3° and 20.3°, respectively, and a correction loss of 1.1° at the last follow-up.

DISCUSSION:
The early detection of a deformity and simple bony fusion in low-magnitude curves can prevent progression of scoliosis and allows for maintenance of a compensated spine. Hemivertebra excision with compression instrumentation results in a better surgical correction of the deformity. The average 61 % correction rate achieved in our patients is in agreement with the results reported by authors using the same surgical technique, as well as with the results of posterior hemivertebra resection. The best correction, 78 %, has been achieved with surgery at a very young age. Complications associated with the two techniques are rare.

CONCLUSIONS:
Congenital scoliosis due to failure off either formation or segmentation is indicated for surgical treatment at young age. Its early detection and subsequent surgical treatment at young age. Its early detection and subsequent surgical correction of the curve result in a long-term maintenance of a compensated spine. Instrumented hemivertebra excision provides the highest rate of correction, particularly if carried out before 3 years of age.

Klíčová slova: congenital scoliosis, hemiepiphysiodesis, hemivertebrectomy

Přijato: 11. únor 2008; Zveřejněno: 1. červen 2008  Zobrazit citaci