作　　者： (刘虎）; (张学军）; (曹隽）; (祈新宇）; (白云松）; (郭东）; (李浩）;

机构地区： 国家儿童医学中心首都医科大学附属北京儿童医院骨科,北京100045

出　　处： 《中国骨与关节外科》 2017年第3期187-190,194,共5页

摘　　要： 背景:脊柱朗格罕细胞组织细胞增生症(Langerhans cell histiocytosis,LCH)患儿行后路器械局部固定术后,病变椎体的生长等问题缺乏相关报道。目的:评价LCH椎体破坏患儿行后路器械矫形固定术的治疗效果,及随访观察术后矫正效果的维持情况。方法:回顾性分析因椎体破坏入院治疗且病理确诊为LCH患儿的临床资料。所有患儿术前及内固定取出前均拍摄站立位脊柱正侧位X线片并行脊柱CT检查,测量椎体病变部位冠状位Cobb角、矢状位后凸角、椎体高度。末次随访复查脊柱正侧位X线片并测量冠状位Cobb角、矢状位后凸角、椎体高度。比较后路矫形手术前后、内固定取出时、末次随访时椎体破坏部位冠状位Cobb角、矢状位后凸角、病变椎体高度变化。结果:共纳入21例患儿。与术前比较,术后Cobb角(18.6°±13.2°vs 4.4°±3.4°)和局部后凸角(4.7°±17.2°vs-0.1°±10.4°)降低(P<0.01)。首次手术后与取出内固定器械后Cobb角及局部后凸角比较,差异无统计学意义(P>0.05)。内固定器械取出后与末次随访Cobb角及局部后凸角比较,差异无统计学意义(P>0.05)。与手术前比较,取出内固定器械后病变椎体高度增加[(8.2±4.3)mm vs(9.3±3.7)mm,P<0.01]。与取出内固定器械后比较,末次随访时病变椎体高度增加[(9.3±3.7)mm vs(10.5±4.7)mm,P<0.01]。后路器械固定术后至内固定取出期间椎体年生长速度与内固定取出后至末次随访期间椎体年生长速度比较,差异有统计学意义[(0.5±0.2)mm/y vs(1.0±1.0)mm/y,P<0.05]。结论:脊柱LCH患儿经后路手术可改善局部后凸及侧弯畸形,其矫形效果能稳定维持,病变椎体术后能继续生长。 Background： There are few reports on the growth of diseased vertebral body and related issues after local fixation in children with Langerhans cell histiocytosis（LCH） in spine. Objective： To evaluate the outcomes of posterior spinal fixation in LCH children with vertebral destruction and to observe the maintenance of the operative correction. Methods： A retrospective analysis was performed in LCH children with vertebral destruction confirmed by pathology in our hospital. All children were examined with anteroposterior and lateral X-ray photographs and CT scanning to measure the coronal Cobb angle, sagittal kyphosis angle and vertebral height in vertebral lesions before surgery and before removing of the internal fixation, and re-examined with anteroposterior and lateral X-ray photographs to measure the coronal Cobb angle, sagittal kyphosis angle and vertebral height in vertebral lesions at the final follow-up. Results： A total of 21 patients were selected in this study. Cobb angle（4.4°±3.4° vs 18.6°±13.2°） and sagittal kyphosis angle（-0.1°±10.4° vs 4.7°±17.2°） decreased after operation（P〈0.01）. There was no significant difference in Cobb angle or kyphosis angle between the time points of postoperation and the removal of the internal fixation, between the time points of the removal of the internal fixation and the final follow-up（P〈0.05）. The mean vertebral height in the lesion was significantly higher after the internal fixation removal than before operation（[8.2±4.3] mm vs [9.3±3.7] mm, P〉0.01）. The mean vertebral height in the lesion was significantly higher at final follow-up than that after the removal of internal fixation（[9.3 ± 3.7] mm vs [10.5 ± 4.7] mm, P〈0.01）. The annual growth rate was significantly higher from the internal fixation removal to final follow-up than from the posterior instrumentation to the internal fixation removal（[0.5±0.2] mm/y vs [1.0±1.0] mm/y, P〈0.05）. Conclusions： Posterior spinal surgery in children with LCH ca

关 键 词： 朗格罕细胞组织细胞增生症 椎体破坏 后路器械矫形内固定