后路三柱截骨矫形术治疗先天性颈胸段脊柱畸形的安全性及并发症分析

Analysis of the safety and complications of posterior three-column osteotomy in the treatment of congenital cervicothoracic deformity

中文关键词:  颈胸段  先天性脊柱畸形  截骨术  并发症

英文关键词:Cervicothoracic  Congenital spinal deformity  Osteotomy  Complications

中文摘要:

  【摘要】 目的：探讨后路三柱截骨矫形术治疗先天性颈胸段脊柱畸形的疗效、安全性及并发症。方法：回顾性分析2009年1月～2017年3月于我院应用后路一期三柱截骨矫形术治疗的25例先天性颈胸段脊柱畸形患者的病历资料，其中男11例，女14例，年龄3～32岁（12.1±7.1岁）。术前合并神经功能损害6例，其中Frankel分级C级4例，D级2例。测量手术前后及末次随访时的颈胸段主弯Cobb角、局部后凸角、远端代偿弯Cobb角、双肩高度等参数，并观察神经功能转归及并发症。结果：行SRS（Scoliosis Research Society）3级截骨6例，SRS 4级截骨3例，SRS 5级截骨16例。手术时间306.1±101.5min（147～550min），术中失血量1108.0±1000.9ml（150～4500ml）。随访时间37.8±14.0（20～69）个月。颈胸段主弯Cobb角由术前59.5°±28.5°矫正到术后的28.8°±16.9°（P＜0.001），末次随访时为31.6°±16.4°，无明显丢失（P=0.574）。局部后凸由术前39.2°±28.2°矫正到术后的21.1°±14.4°（P＜0.001），末次随访时为24.0°±14.3°，无明显丢失（P=0.478）。远端代偿弯由术前的35.4°±19.5°减少为术后的18.4°±11.3°（P＜0.001），末次随访时为26.1°±16.9°，较术后无统计学差异（P=0.073）。双肩高度差由术前的2.6±0.9cm减少到术后的1.2±0.6cm（P＜0.001），末次随访时进一步改善为0.9±0.6cm，但较术后无统计学差异（P=0.093）。术前合并神经功能损害的6例患者中5例随访期间恢复至Frankel E级，1例C级恢复至Frankel D级。术后神经系统并发症6例：5例凸侧上肢麻木；1例因双下肢肌力持续下降行再次手术探查清除血肿后恢复，6例末次随访时神经功能均恢复正常。其他包括脑脊液漏1例，胸腔积液3例，伤口积液1例，肺部感染1例，远期融合远端侧凸加重行翻修手术2例，均通过对症处理后恢复。结论：对于先天性颈胸段脊柱畸形患者应用后路一期三柱截骨矫形手术治疗，能够获得良好的矫形效果，但存在较高的并发症发生率。

英文摘要:

  【Abstract】 Objectives: To analyze the outcome, safety and complications of one-stage posterior three-column osteotomy in the treatment of congenital cervicothoracic deformity. Methods: From January 2009 to March 2017, 25 patients with congenital cervicothoracic deformity who met the inclusion criteria after one-stage posterior three-column osteotomy in our center were retrospectively reviewed. There were 11 males and 14 females with a mean age of 12.1±7.1 years(ranging from 3 to 32 years). There were 6 patients with neurologic deficit before operation, including 4 patients with Frankel grade C and 2 patients with Frankel grade D. The cervicothoracic curve, local kyphosis angle, distal compensatory curve and shoulder height were measured before and after operation and during final follow-up. The correction rate and the neurological function were observed, as well as the short-term and long-term complications were recorded. Results: SRS(Scoliosis Research Society) grade 3 osteotomy was performed on 6 patients, SRS grade 4 osteotomy was performed on 3 patients, and 16 patients received SRS grade 5 osteotomy. The operation time was 306.1±101.5min(147-550min), and the blood loss was 1108.0±1000.9ml(150-4500ml). The follow-up time was 37.8±14(20-69) months. The cervicothoracic curve was significantly corrected from 59.5°±28.5° preoperatively to 28.8°±16.9° postoperatively(P＜0.001) and 31.6°±16.4° at final follow-up with no significant correction loss(P=0.574). Local kyphosis angle was significantly corrected from 39.2°±28.2° preoperatively to 21.1°±14.4° postoperatively(P＜0.001) and 24.0°±14.3° at final follow-up with no significant correction loss(P=0.478). The distal compensatory curve was corrected from 35.4°±19.5° preoperatively to 18.4°±11.3° postoperatively(P＜0.001), which increased to 26.1°±16.9° at final follow-up but with no significant difference(P=0.073). The height difference between the shoulders was reduced from 2.6±0.9cm preoperatively to 1.2±0.6cm postoperatively(P＜0.001) and furtherly improved to 0.9±0.6cm at final follow-up, but there was no significant difference compared with that after operation(P=0.093). Among the 6 patients with preoperative neurologic deficit, 5 patients recovered to Frankel E and 1 patient from Frankel C to D during follow-up. Postoperative neurological complications occurred in 6 patients: 5 patients showed numbness of the upper limbs of the convex side after operation; 1 patient underwent reoperation due to continuous decrease of lower limb muscle force. Neurological function was cured in all 6 cases during follow-up. 1 patient had cerebrospinal fluid leakage, 3 patients had pleural effusion, 1 patient had wound effusion, and 1 patient developed pulmonary infection. All patients recovered after corresponding treatment. Two patients underwent revision surgery because of the aggravation of distal scoliosis at follow-up. Conclusions: For patients with congenital cervicothoracic deformity, one-stage posterior three-column osteotomy has a high incidence of complications, but the overall effect is good.