
先天性脊柱畸形诊断与治疗
什么是先天性脊柱畸形?
What is Congenital Scoliosis?
Congenital scoliosis is the type that developed because your child’s spine didn’t form correctly in utero. Some of the vertebrae (vertebral segments) in his spine formed abnormally (failure of formation), didn’t separate correctly (failure of segmentation) or there was some combination of both.
As a result, his spine has a side-to-side curvature that has a 75 percent chance of progressing (worsening) if not treated surgically. Because the spine forms at the same time as certain other organ systems in the first six weeks of pregnancy, more than half of affected children have one or more other improperly formed systems. This means that your child’s genitourinary, cardiac, auditory, nervous (neurological, neural) or renal system(s) may also have formed incorrectly or incompletely.
Additional problems of the spine or spinal cord can also be associated with congenital scoliosis.
Resect the Hemivertebra
半椎体切除
分型

1968年Winter在JBJS上分型

1999年McMaster and Singh改良了分型
Ⅰ型 | 椎体前缘形成失败 (后象限椎体、后侧半椎体、蝴蝶椎、前方或前外侧楔形椎) |
Ⅱ型 | 椎体前方分节不良 (椎体前方骨桥、椎体前外侧骨桥) |
Ⅲ型 | 混合畸形 (前外侧骨桥合并对侧后外象限椎体) |
Ⅳ型 | 未分型 |
手术前准备
MR检查
必做,有时可见神经轴索异常
CT扫描
可显示解剖结构,获得前后节段了解畸形情况
半椎体切除技巧
1 | 年龄最好3岁以后 | ![]() |
2 | 单截断切除可以用横联来提高稳定性 | |
4 | 年龄大的患儿,单纯后路切除即可 | |
5 | 年龄小于8岁的患儿术后Pantaloon石膏或支具固定6周 |
以上资料部分参考TSRH医院 Sucato教授,2014
《When Where and How to Resect a Hemivertebra》
Operation Video
半椎体切除录像
超声骨刀切除半椎体
传统蛋壳技术切除半椎体

半椎体切除标准示意图

1
先天性脊柱侧弯存在明显的个体差异,疾病进展及预后均存在显著不同,所以需要早期筛查、评估,确定个体化的治疗方案及干预措施。
半椎体切除融合案例


进展型半椎体切除

腰椎半椎体切除
2
单一半椎体导致的脊柱畸形,在出生后尽早手术一般一次性半椎体切除短节段融合固定手术是可以治愈的,达到和正常孩子一样的生长发育和生活。


胸椎半椎体切除

Plaster/brace orthopedics
石膏/支具矫形



延缓手术治疗——石膏与支具
随着国家儿童医学中心儿童脊柱外科技术发展和高精尖的辅助设备引进,手术难度和风险变得可控。
对于复杂性长节段先天性脊柱畸形可以采用早期石膏固定拖延、生长棒固定支撑延长、最终长节段融合固定也可以取得不错的疗效,极大改善此类患儿的生活质量和延长寿命。



About
复旦大学附属儿科医院骨科
国家儿童医学中心&复旦大学附属儿科医院骨科脊柱团队致力于儿童脊柱外科的发展。作为主要的综合性项目,医院打造了有力的脊柱外科多学科团队,并配置了高级先进的手术设施,确保儿童脊柱外科手术的精准医疗,保障手术儿童的安全与康复。
我们儿童骨科中心每年有10万的门诊病人,进行4000多例手术,是上海有名的儿童骨科诊疗中心。团队学习欧美理念,对患有肌肉骨骼系统的先天性、神经肌肉、发育和创伤后问题的儿童及青少年提供优质先进的医疗服务,针对儿童早发性脊柱侧弯开展支具、石膏矫形、短节段手术根治、生长棒技术、脊柱融合等多种方式个体化治疗,有着丰富的经验和满意的疗效。


手术康复后的儿童参加中国白俄罗斯一带一路交流
脊柱外科团队
王达辉
骨科主任
副主任医师
周四下午(高专)
周五上午:副主任门诊
先天性脊柱侧弯罕见病门诊

郑一鸣
主治医师
复旦丄医临床医学硕士
擅长小儿脊柱外科领域
周一上/周五下
脊柱外科门诊

吴春星
主治医师
上海交大医学院博士
擅长儿童脑瘫、斜颈等治疗
周一上午
脑瘫(骨科)急诊

景延辉
主治医师
复旦丄医医学硕士
擅长骨折微创与先天畸形
周四上
髋关节疾病门诊

钱闯
住院医师
复旦儿科学博士研究生
擅长儿童脊柱侧弯的诊治
周一至周五
骨科门急诊

孟俊融
住院医师
复旦上医临床医学博士
擅长脊柱外科与骨质疏松
周一至周五
骨科门急诊
ABOUT US
National Children’s medical center & Children’s hospital of Fudan University Spinal Programis dedicate to pediatric spine surgery. We’ll provide your child with the most advanced diagnostics and treatments—several of which were developed by our own researchers and clinicians. As one of the first comprehensive programs, Children’s hospital of Fudan University Children’s Orthopedic Centeris well-know and experienced pediatric orthopedic surgery center in Shanghai, performing more than 4,000 surgical proceduresand 100 thousands out-patientseach year.
Our program is the nation’s preeminent care center for children with congenital, neuromuscular, developmental and post-traumatic problems of the musculoskeletal system.For children with early onset scoliosis, various individualized treatment methods, such as braces, Metha series cast methods, short segmentfusionsurgery, growth rod technology, spinal fusion, have rich experience and satisfactory effect.

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复旦大学附属儿科医院骨科



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