摘要
目的分析脊柱矫形术中发生严重神经并发症的自然转归及其预后不良的危险因素。方法2000年1月至2017年12月期间7851例脊柱畸形患者接受矫形手术治疗,回顾性分析发生单侧或双侧下肢全瘫或不全瘫等严重神经并发症59例患者的临床资料,男28例,女31例;年龄为25.0±16.3岁(范围6~71岁)。青少年特发性脊柱侧凸6例,先天性脊柱侧凸22例,神经肌源性脊柱侧凸10例,Ⅰ型神经纤维瘤病伴脊柱侧凸5例,其他类型脊柱侧凸16例。5例患者为双下肢完全性瘫痪,17例患者为双下肢不全性瘫痪,37例患者为单侧下肢不全性瘫痪。根据损伤原因,机械性损伤患者分别予螺钉拔出、血肿清除、松开矫形、椎板切除减压处理,缺血性脊髓损伤患者予扩容升压处理。按照美国脊柱损伤协会(American Spinal Injury Association,ASIA)提出的神经分级标准评估患者神经功能恢复情况。通过Fisher精确检验及Logistics单因素回归分析临床因素、围术期因素与患者神经功能未恢复的相关性,将P<0.10的因素纳入多因素Logistic回归分析确定相关危险因素。结果严重神经并发症发生率为0.75%(59/7851)。至末次随访时42例(71.2%)患者获得完全恢复,10例(16.9%)患者获得部分恢复,其中44例(74.6%)患者的神经功能恢复发生在术后6个月以内;余7例患者未获得恢复,包括Ⅰ型神经纤维瘤病3例(ASIA分级A级1例、C级2例)、休门氏病1例(ASIA分级C级)、先天性关节屈曲挛缩1例(ASIA分级B级)、小儿麻痹症1例(ASIA分级C级)和特发性脊柱侧凸1例(ASIA分级A级)。Fisher检验结果提示未恢复组病因学分类的差异有统计学意义(P=0.007),Logistics单因素回归分析显示可能的危险因素包括Ⅰ型神经纤维瘤病(OR=18.750,P=0.005)、术前合并脊髓神经损害(OR=5.750,P=0.046)、主弯Cobb角>90°(OR=4.444,P=0.073)及神经功能完全性损伤(OR=6.533,P=0.067),进一步Logistic多因素回归分析显示病因学�
Objective To analyze the natural history and outcomes of major neurological complications in spinal deformity correction surgery and to determine the risk factors for no neurological recovery.Methods All of 7851 patients with spinal deformity who underwent deformity correction from January 2000 to December 2017 were reviewed.Major neurological complication featured by complete or incomplete paralysis of single or both lower extremities was identified in 59 patients,including 28 males and 31 females with an average age of 25.0±16.3(range 6 to 71 years old).Among these cases,6 were adolescent idiopathic scoliosis,22 were congenital scoliosis,10 were neuromuscular scoliosis,5 were neurofibromatosis type 1,and 16 were other types.5 patients had complete paraplegia of the lower limbs,17 patients had incomplete paralysis of the lower limbs,and 37 patients had incomplete paraplegia of unilateral lower limb.Treatment included implant removal,debridement of hematoma,loosening the fixation and decompression by laminectomy for mechanical injury,as well as transfusion and press agent for ischemic injury.The neurological function was determined by the American Spinal Injury Association(ASIA)grading system.Fisher exact test and univariate logistics regression were used to determine the association between clinical,surgical parameters and no recovery of neurological function.For the identified factors with P value<0.10,multiple logistics regression was used to determine the independent risk factor for no recovery.Results The incidence of major neurological complications was 0.75%(59/7851).At final follow-up,42 patients(71.2%)had complete recovery and 10 patients(16.9%)had partial recovery,and 44 cases(74.6%)had recovery within 6 months.There were 7 cases had no recovery,including 3 with type I neurofibromatosis(ASIA:1 grade A,2 grade C),1 with Scheuermann's disease(ASIA:grade C),1 with arthrogryposis multiplex congenital(ASIA:grade B),1 with poliomyelitis related scoliosis(ASIA:grade C),and 1 with idiopathic scoliosis(ASIA:gra
作者
李劼
钱至恺
汤子洋
胡宗杉
王斌
俞杨
邱勇
朱泽章
刘臻
Li Jie;Qian Zhikai;Tang Ziyang;Wang Bin;Yu Yang;Qiu Yong;Zhu Zezhang;Liu Zhen(Department of Spinal Surgery,Drum Tower Hospital,Nanjing University Medical School,Nanjing 210008,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2021年第13期815-824,共10页
Chinese Journal of Orthopaedics
基金
十三五南京市卫生青年人才培养工程(QRX17126)
江苏省临床医学中心(YXZXA2016009)。
关键词
脊柱侧凸
脊髓损伤
手术中并发症
手术后并发症
Scoliosis
Spinal cord injuries
Intraoperative complications
Postoperative complications
