摘要
目的 探讨后路全脊椎截骨治疗严重僵硬性先天性脊柱畸形的神经系统并发症及其危险因素.方法 收集2007年6月至2012年11月在第四军医大学西京医院接受后路全脊椎截骨治疗的88例严重僵硬性先天性脊柱畸形患者的临床资料,男性39例,女性49例,年龄6～46岁,平均16.9岁.测量患者术前、术后及随访时Cobb角、平衡情况,记录手术情况、神经系统并发症及随访情况等.对患者的年龄、Cobb角、手术时间、体重指数、肺功能、出血比、截骨部位、固定椎体数、切除椎体数、使用cage/钛网情况、术前神经功能状况、畸形类型、合并椎管内畸形情况进行单因素分析,对有意义的因素进行多因素Logistic回归分析.结果 所有患者平均随访42个月（19 ～ 83个月）,平均切除椎体1.3个（1～3个）,平均手术时间502 min（165 ～ 880 min）,平均出血量2 238 ml（100 ～11 500 ml）,平均出血比69.3％（9％ ～299％）.冠状位Cobb角由术前平均93.6°矫正至22.2°,末次随访22.9°,矫形率76.8％.冠状位失衡（绝对值）由术前平均2.5 cm减少至1.3 cm.矢状位Cobb角由术前平均88.2°矫正至28.7°,末次随访29.2°,矢状位Cobb角平均减少59.0°.矢状位失衡（绝对值）由术前平均3.1 cm减少至1.2 cm.发生神经系统并发症12例（13.6％）.手术时间≥480 min、肺功能异常、出血比＞50％、T7～T9截骨及术前神经功能异常患者神经系统并发症发生率较高（P=0.046,0.000,0.000,0.033,0.043）.结论 后路全脊椎截骨治疗严重脊柱畸形疗效显著,肺功能异常、出血比＞50％是发生神经系统并发症的高危因素.
Objective To analyze the risk factors of neurological complications of posterior vertebral column resection in the treatment of severe rigid congenital spinal deformities.Methods The clinical data of 88 patients with severe rigid congenital spinal deformities who underwent PVCR in Department Of Orthopaedics,Xijing Hospital,Fourth Military Medical University from June 2007 to November 2012 were collected.There were 39 males and 49 females at the average age of 16.9 years （range 6-46 years）.To measure the Cobb angle and balance at preoperative,postoperative and follow up,and to record the operation report,neurological complications and at follow up.The relevant factors of neurological complications were analyzed by one-way analysis,including：age,Cobb angle,operation time,body mass index,pulmonary function,blood volume loss,resection level,number of vertebrae fixed,number of vertebrae resected,usage of cage or titanium mesh,preoperative neurologic function,the type of deformity and combination of spinal canal deformity,and further analyzed by multiariable Logistic regression analysis.Results The average follow up was 42 months （range 19 to 83 months）.The number of resected vertebrae average 1.3 （range 1 to 3）,operative time average 502.4 min（range 165.0 to 880.0 min）,estimate blood loss average 2 238 ml（range 100 to 11 500 ml） for an average 69.3% blood volume loss （range 9% to 299%）.The average preoperative major coronal curve of 93.6° corrected to 22.2°,at the final follow-up,the coronal curve was 22.2° with a correction of 76.8%.The average preoperative coronal imbalance （absolute value） was 2.5 cm decreasing to 1.3 cm at the final follow-up.The average preoperative major sagittal curve of 88.2° corrected to 28.7°,at the final follow-up,the sagittal curve was 29.2°,average decrease in kyphosis of 59.0°.The average preoperative sagittal imbalance （absolute value） was 3.1 cm decreasing to 1.2 cm at the final followup.There were 12 patients （13.6%） developed a neurologica
出处
《中华外科杂志》
CAS
CSCD
北大核心
2015年第6期424-429,共6页
Chinese Journal of Surgery
关键词
先天性脊柱畸形
全脊椎截骨
并发症
危险因素
肺功能
出血比
Congenital spinal deformities
Vertebral column resection
Complications
Risk factors
Pulmonary function
Blood volume loss
