Congenital Scoliosis Orthopaedic Pedicle Screws Posterior Fixation Clinical Research

Objective: Congenital scoliosis is secondly to idiopathic scoliosis kind ofspinal deformity, is in the process of development of embryos spine, vertebralform defects and (or) failure of segmentation caused by a congenitalmalformation, the spine bilateral symmetry growth and appear scoliosis. Afterbirth deformities that children appear, with growth deformity children oftengradually deteriorated. If not active intervention, the majority of childrenbefore the age of10can become serious scoliosis deformity, especially in thesecond growth peak deformity will further increase, will cause severe spinaland thoracic deformity, influence of children of the cardiovascular function,digest function and systemic nutrition, not only affects the physical and mentalhealth of the children, but also children will shorten life. Especially fullysegment hemivertebra caused by scoliosis congenital malformation, because tfully segment hemivertebra up and down with complete disc and growseventually board, children with growth and development, deformity willfurther weaken, should be early surgical treatment. With the pedicle screwtechnology matures and the improvement of operative techniques, and isolatedposterior removal of teratogenic factors of a pedicle screw and rod systemfixation in the treatment of congenital kyphoscoliosis achieved good clinicalefficacy. This study was a retrospective analysis to evaluate the clinicalefficacy of short-term clinical study of pedicle screw fixation for the treatmentof congenital kyphoscoliosis.Methods: Review from March2010to December2011,32cases weretreated scoliosis, except for eight cases of idiopathic scoliosis, congenitalscoliosis,24cases, of which22cases were followed up13cases, male andfemalenine cases, the average age of7.1years (2to16years old), fullysegmented hemivertebra15cases, bad three cases of vertebral sub-section, a hybrid of four cases, a simple, fully segmented hemivertebra, vertebralpointsbad section, non-structural compensatory curve of15cases of patientswith a posterior pedicle hemivertebra resection, short-segment pedicle screwfixation and fusion; concomitant structural compensatory hemivertebra bend,Risser sign greater than grade II in2patients, posterior pedicle hemivertebraresection, longer segments orthopedic compensatory curve fusion surgery;mixed at the same time compensatory curve for structured curved three caseschildren underwent posterior release, osteotomy long segment orthopediccompensatory curve fixed fusion. Vertebral sub-section of non-performing,non-structural compensatory curve1patient underwent posterior shortsegment fixation in orthopedic pedicle screw fixation growth valve, accordingto the growth and orthopedic posterior distraction lengthening surgery, duringfollow-up in softened extend. All patients were wearing the brace3to6months, until the follow-up film, X-ray orthopedic segment spinal fusion,before removal of the brace. Comparison of preoperative, postoperative andlast follow-up whole spine lateral X-ray, measure and record the scoliosis andkyphosis Cobb angle and apical vertebral offset, evaluation of coronal andsagittal orthopedic effect. And review of cases, statistical analysis, operativetime, blood loss and related complications.Results: Operative time was120~420min, the average time220.3minbleeding volume50~3000ml, mean blood loss was676.5ml. All patientsfollow-up of3months to24months, with an average follow-up8.1patienthemivertebrae removal of the convex side of segment pressure end of thevertebral pedicle cut down in the surgery extension of a vertebral fixation; twocases of postoperative convex side of the body radiating pain,2days afterrecovery normal; postoperative wound healing of stageⅠ, no deep infection,respiratory failure, or deep vein thrombosis and other complications occurred.Preoperative scoliosis, the average Cobb angle of43.75°(28°~97°),postoperative Cobb angle was an average of13.85°. The average correctionrate of68.34%. The final follow up Cobb angle was an average of12.55°, theaverage correction rate of71.31%. Perioperative convex Cobb angle was 22.15°, the average postoperative Cobb angle of5.85°. The averagecorrection rate of73.40%. The final follow up Cobb angle averaged5.75°, anaverage correction rate of74.04%. Before surgery, after apical vertebral offsetwere26.45mm and10.05mm, an average correction of16.40mm, the lastfollow-up is8.83mm. Six months and fusion, the continuity of bone structureto connect the gap in vertebral resection, surgery received orthopedic point ofview no significant loss of Follow-up period all patients phenomena such asloosening or breakage of the crankshaft phenomenon and pedicle cutting theincidence of complications.Conclusions: Congenital scoliosis surgery is a complicated systemengineering, and there are many risk factors, the key to the success of theoperation in the right time choosing personalized operation program, makecareful planning. The operation plan should combine patients age, in view ofthe different teratogenic factors and deformity circumstance, choose the rightoperation methods and fixed range. The operation mode and curative effectdepends on age children, early diagnosis and deformity itself characteristics.As of pedicle screws of mature, surgical technique has improved and thedevelopment of the related equipment, posterior removal of relatedaggravating factors of the development of the deformity teratogenicorthopaedic pedicle screws fixation of small trauma, less complications,coronal and sagittal alignment orthopaedic satisfaction.