青少年特发性脊柱侧凸再手术原因分析与策略

Cause analysis of and surgical strategy for revision surgery for adolescent idiopathic scoliosis

中文关键词:  青少年特发性脊柱侧凸  再手术  并发症

英文关键词:Adolescent idiopathic scoliosis  Reoperation  Complication

中文摘要:

  【摘要】 目的：分析青少年特发性脊柱侧凸初次术后再手术常见原因，并探讨治疗策略及预防措施。方法：2003年1月～2008年12月我院收治的特发性脊柱侧凸再手术病例10例，收集其初次矫形术前、术后随访及再手术术后的相关影像资料、初次手术和再手术策略等资料进行回顾性分析。结果：10例中5例因侧凸进展而采用延长融合范围治疗；1例因近端交界后凸加剧而需向近端延长融合范围；3例感染患者接受了清创及抗生素治疗，其中2例保留了内固定，1例为控制感染而取出内固定；1例假关节形成患者采用更换断裂内固定及局部植骨治疗。所有患者经随访12～33个月（平均21.5个月），脊柱平衡保持良好，无侧凸进展、失代偿、内固定失败等并发症。结论：特发性脊柱侧凸术后常见再手术原因包括侧凸进展、感染、假关节形成、近端异常交界后凸等，选择合适的再手术策略可以取得满意的疗效。

英文摘要:

  【Abstract】 Objective：To investigate the common causes and surgical strategy for revision surgery for adolescent idiopathic scoliosis.Method：10 patients underwent revision surgery due to failed primary spinal fusion surgery in our hospital from January　2003 to December 2008.Their detailed image data collected pre- and postoperatively，during the follow-up and the revision surgery，as well as the surgical strategies for both primary and revision surgery were collected and reviewed retrospectively.Result：Of 10 revision surgeries，fusion segments were extended due to progressive scoliosis in 5 surgeris；1 patient underwent proximal fusion extension due to proximal junctional kyphosis；3 patients had debridement and antibiotic therapy due to infection and instrument were maintained in 2 cases；1 patient underwent implant replacement and autograft due to pseudarthrosis and instrument failure.All 10 patients were followed up for 12～33 months（average，21.5 months）.At final follow-up，no malalignment，no scoliosis progression and disimbursement and instrument failure were　noted.Conclusion：The most common causes for revision surgery for adolescent idiopathic scoliosis are curve progression，infection，pseudarthrosis and abnormal proximal junctional kyphosis.Proper revision strategy can ensure satisfactory results.