摘要
目的探讨应用Ⅰ期后路全脊椎切除治疗重度胸腰椎畸形的神经系统并发症，并分析相关危险因素。方法2000年2月-2010年9月接受Ⅰ期后路全脊椎切除治疗的重度胸腰椎畸形患者67例，男29例，女38例；年龄14～62岁，平均31．4岁。其中青少年（年龄〈18岁）21例，成人（年龄≥18岁）46例。侧凸畸形11例，平均冠状面主弯Cobb角90．4°；侧后凸畸形25例，冠状面主弯Cobb角94．5°，后凸角度平均65．5°；角状后凸畸形28例，平均后凸角74．3°；圆弧状后凸3例，平均后凸角91．1°。初次手术患者59例，翻修患者8例。采用主弯区顶椎全脊椎切除，全节段椎弓根螺钉内固定矫形和360。植骨融合术，统计神经系统并发症的发生情况。结果平均随访时间14个月（3～69个月），出现神经系统并发症者共8例（11．9％），其中严重神经并发症3例，发生率4．5％，包括1例大量失血血容量灌注不足导致完全性脊髓损伤。轻度神经并发症患者5例，发生率7．5％。胸椎全脊椎切除的神经损伤发生率要明显高于腰椎（P〈0．05）。多个椎体切除的并发症发生率显著增加（P〈0．05）。术前已经伴有或者不伴有神经损害表现患者的神经并发症发生率分别为33．3％和7．3％（P〈0．05），翻修手术的并发症发生率明显增加（P〈0．05）。差异虽无统计学意义（P〉0．05），但出现神经系统并发症的8例患者术前均合并有严重的后凸畸形（〉60°）。结论Ⅰ期后路全脊椎切除是外科治疗重度胸腰椎畸形有效手术方式，但神经并发症应引起关注。相关神经损伤危险因素包括术中操作不当、大量失血、术前已经有神经受损表现、胸段截署名个椎体切除翻修手术和严重后凸．
Objective To analyze the neurological complications in treatment of severe thoracolumbar spinal deformity with one stage posterior vertebral column resection （pVCR） and discuss the related risk factors. Methods There were 67 patients with severe thoracolumbar spinal deformity who underwent one-stage pVCR from February 2000 to September 2010. There were 29 males and 38 females at an average age of 31.4 years old （range, 14-62 years）. There were 21 patients at age less than 18 years old and 46 at age more than 18 years old. Patients were divided into four pathological types： severe scoliosis group （n=11, mean Cobb angle 90.4°）, kyphoscoliosis group （n =25, mean scoliosis 94.5°, and mean kyphosis 65.5°）, angular kyphosis group （n = 28, mean kyphosis 74.3°） and global kyphosis group （n = 3, mean kyphosis 91. 1°）. Of all the patients, 59 patients underwent primary surgery and eight underwent revision surgery. Surgical methods included posterior apex vertebral column resection, segemental pedicle screw fixation and correction as well as 360° bone fusion. Neurological complication was statistically analyzed. Results The average follow-up was 14 months （range, 3-69 months ）, which showed severe neurologic complication in eight patients （ 11.9% ） after surgery. Severe neurologic complication occurred in three patients （4.5%）, among whom one patient presented delayed complete paraplegia 23 hours after surgery. Five p^ients had mild neuJ：ologic deficits （7.5 % ） , the incidence of which was higher than 23.1% for thoracic osteotomy （P 〈 0.05）. Multilevel pVCR had high rate of neurological complications （P 〈 0.05 ）. The incidence rate was 33.3% for patients with preoperative neurologic compromise and 7.3% for patients without preoperative neurologic compromise （ P 〈0.05 ）. The incidence rate was increased in the revision surgery （P 〈 0. 05）. Eight patients with neurological deficits had kyphotic angle of more than 60° although there was no statistical
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2011年第6期492-496,共5页
Chinese Journal of Trauma
