曾 岩,陈仲强,郭昭庆,齐 强,李危石,孙垂国.中-重度脊柱后凸成角畸形后路矫形手术的并发症及其对策[J].中国脊柱脊髓杂志,2011,(6):468-473. |
中-重度脊柱后凸成角畸形后路矫形手术的并发症及其对策 |
中文关键词: 脊柱后凸 后凸矫形 并发症 |
中文摘要: |
【摘要】 目的:探讨后路后凸节段切除、双轴旋转矫形手术治疗中-重度脊柱后凸成角畸形的手术并发症及其对策。方法:2004年5月~2009年10月采用后路后凸节段切除、双轴旋转矫形技术治疗中-重度脊柱后凸成角畸形患者40例,其中陈旧骨折3例,陈旧结核26例,先天性半椎体10例,医源性(肿瘤切除术后)1例;后凸顶椎位于胸腰段和下胸段22例,中胸段17例,上胸段1例。术前常规行X线片、CT和MRI检查,测量后凸角度,评价其后凸部位和特点,以及神经功能情况。总结患者术中和术后并发症,并积极采取相应补救处理措施。结果:术后平均随访26.3个月。患者术前平均后凸角度为89.7°,术后平均为26.2°,矫正率为71.8%。术中和术后并发症包括硬膜损伤3例,神经根损伤5例,人工椎体松动1例,截骨处移位1例,由于术中血压降低、脊髓缺血引起的术后短期下肢功能障碍2例,术后内固定松动后凸复发1例。上述并发症分别经过术中修补或覆盖硬膜缺损,术后脱水、激素和神经营养药物,二次手术减压、内置物调整、再矫形和重新稳定脊柱等处理措施,均获得较好恢复。结论:中-重度脊柱后凸畸形手术治疗的风险较高,需要对其并发症进行积极预防和应对,多数并发症经过正确治疗,能获得较好的效果。 |
The complications and management of posterior correction for moderate/severe kyphosis |
英文关键词:Kyphosis Kyphosis correction Complication |
英文摘要: |
【Abstract】 Objective:To investigate the complications and management of posterior kyphotic segmental resection and dual axial rotation correction for moderate/severe kyphosis.Method:From May 2004 to October 2009,posterior kyphotic segmental resection and dual axial rotation correction was performed in 40 patients with moderate/severe kyphosis.The pathological diagnosis included post-traumatic kyphosis in 3 cases,old tuberculous kyphosis in 26 cases,congenital semi-vertebral kyphosis in 10 cases,and iatrogenic(after operation for tumor) kyphosis in 1 case.The kyphotic apex sited at thoracolumbar segment and lower thoracic segment in 22 cases,at middle thoracic segment in 17 cases,at upper thoracic segment in 1 case.The X-ray,CT scan and MRI were routinely performed before surgery to measure the kyphotic Cobb′s angle,the kyphosis level and characteristics,as well as the compression of spinal cord were evaluated.The intra- and post-operative complications were summarized,and the relevant management undertaken was noted.Result:The average follow-up was 26.3 months.The average preoperative kyphosis Cobb′s angle was 89.7°,which decreased to 26.2° after surgery,with an average correction rate of 71.8%.The complications included dural tear in 3 cases,nerve root injury in 5 cases,prosthesis loosening in 1 case,osteotomy segment shift in 1 case,transient neurologic deficit in 2 cases due to dropping of blood pressure and ischemia of spinal cord,and instrumentation loosening and kyphosis recurrence in 1 case.All complications got good relief after relevant intervention including dural repair or covering of the defect,dehydration,methylprednisolone or mecobalamine treatment,and revision surgery for decompression.Conclusion:High surgical risk is noted in moderate/severe kyphosis correction.The complications should be managed cautiously, and the results are promising after proper intervention. |
投稿时间:2011-01-04 修订日期:2011-04-11 |
DOI:10.3969/j.issn.1004-406X.2011.6.468.5 |
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