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

The complications and management of posterior correction for moderate/severe kyphosis

中文关键词:  脊柱后凸  后凸矫形  并发症

英文关键词:Kyphosis  Kyphosis correction  Complication

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。

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.