Operaţii de reconstrucţie în diformităţile scoliotice la copii

Abstract

Introduction. The choice of surgical and therapeutic options in the management of spine deformations in children is still controversial. Aim to: improve the quality of life of children with spine deformations, through the implementation of the surgical treatment algorithm. Material and methods. Fifty-seven children with scoliosis of different etiology werw admitted to the Clinic of Vertebrology, Orthopedics and Traumatology of the Scientific and Practical Center of Children’s Surgery “Natalia Gheorghiu”. For deformations correction was used polysegmentary constructions techique. Results. The main objectives of surgical interventions were the elimination of the compression factor, deformation and disbalance correction and spine stabilization. Surgery allowed obtaining the following results: 1. Reposition (reduction) of the body of displaced vertebras; 2. Reconstruction of forward and average spine columns; 3. Restoration of physiological spine profiles (frontal and sagittal); 4. Restoration of normal anatomy of the vertebral channel; 5. Stabilization of the spine-impellent segment. The comparative analysis of the quality of life of patients with severe spine deformations (according to the questionnaire „EQ-5D”), before and after surgical intervention, has shown that the quality of life of patients in postoperative period essentially improved, in comparison with the preoperative period (12,7±0,3 vs. 6,7±0,1). The long-term outcomes of the surgical treatment were good in 39 (68,4%) patients, satisfactory in 12 (21,1%) cases, and unsatisfactory in 7(12,3%) children. Conclusion 1. The algoritm of surgical treatment of spine deformations and further prognosis depend on the type of neurologic infringements and the character of bones’ damages. 2. The differential election of treatment option in spine deformation management depends on the age of patient, extent of deformation, spine mobility and neurologic impairment; application of high technologies allows achieving good results in this category of patients.

В Клинике вертебрологии, ортопедии и травматологии Научно-практического Центра Детской Хирургии «Н.Георгиу» за последние 5 лет прооперировано 57 детей с сколиозом диспластической этиологии, у которых для коррекции деформации использовались полисегментарные конструкции. Использование полисегментарной конструкции позвоночника у больных позволило получить коррекцию 42-78% первичной величины деформации. Сравнительный анализ качества жизни пациентов с тяжёлыми деформациями позвоночника (согласно опроснику „EQ-5D”) до и после хирургического вмешательства показал, что в постоперационный период качество жизни пациентов существенно улучшилось по сравнению с предоперационным периодом – от 12,7±0,3 пунктов до 6,7±0,1. Отдалённые результаты хирургического лечения: хорошие – у 39 детей (68,4%), удовлетворительные – у 12 детей (21,1%), неудовлетворительные – у 7 (12,3%).