脊柱侧凸矫形术后严重冠状面失衡再次手术翻修的疗效及并发症

Effects and complications of revision surgery for severe coronal imbalance after scoliosis correction

中文关键词:  脊柱侧凸  冠状面失衡  翻修手术  不对称截骨

英文关键词:Scoliosis  Coronal imbalance  Revision surgery  Asymmetric osteotomy

中文摘要:

  【摘要】 目的：观察脊柱侧凸矫形术后发生严重冠状面失衡进行再次手术翻修的效果及并发症。方法：回顾性分析我院2013年1月~2021年8月手术治疗的7例脊柱侧凸矫形术后严重冠状面失衡患者的临床资料，其中男性3例，女性4例；本次手术年龄21.3±7.5岁（14~32岁）。随访16.3±4.2个月（12~25个月）。统计初次手术年龄、既往手术次数、本次手术时间、出血量和固定节段。在本次手术前、术后即刻及末次随访时在全脊柱正侧位X线片上测量主胸弯及腰弯Cobb角、最下固定椎倾斜角、冠状面平衡距离（coronal balance distance，CBD）、冠状面骨盆倾斜角等，计算CBD的矫正率。术前、术后即刻及末次随访时使用SF-36量表评估患者生活质量。记录本次手术后各类并发症发生及转归情况。结果：初次手术年龄8.86±4.14岁（3～15岁）；手术次数5.29±3.55次（2～13次）；本次手术时间为346.14±64.65min，术中出血量1342.86±687.65ml；6例患者行不对称性PSO截骨，1例患者行多节段Ponte截骨、延长内固定融合节段。术前CBD为77.23±33.28mm，术后即刻为36.11±15.14mm，较术前改善（P＜0.05），矫正率为（53±3）%，末次随访为35.91±14.45mm，与术后即刻相比无明显差异（P＞0.05）。主胸弯、最下固定椎倾斜角及冠状位骨盆倾斜角术后即刻均较术前明显减少（P＜0.05），末次随访与术后即刻无显著性差异（P＞0.05）。术前腰弯21.29°±17.77°，术后即刻30.14°±8.86°，较术前有统计学差异（P＜0.05），末次随访腰弯30.14°±8.13°，与术后无显著性差异（P＞0.05）；术前SF-36综合评分27.29±1.98分，术后即刻36.86±2.27分（P＜0.05），末次随访时50.14±3.24分（P＜0.05）。5例患者术后出现胸腔积液、脑脊液漏、下肢神经痛等并发症，均在住院期间完全治愈。结论：脊柱侧凸矫形术后出现严重冠状面失衡的患者，再次翻修截骨手术可取得较好的矫正效果并提高生活质量，但手术风险大，围手术期需密切关注并发症。

英文摘要:

  【Abstract】 Objectives: To observe the effects and complications of revision for severe coronal imbalance after scoliosis correction surgery. Methods: A retrospective analysis was performed on the clinical data of 7 patients with severe coronal imbalance after scoliosis correction surgery who underwent reoperation and revision at our hospital from January 2013 to August 2021, including 3 males and 4 females, aged 21.3±7.5 years (14-32 years). The follow-up period was 16.3±4.2 months, ranging from 12 to 25 months. The age of the first operation, number of previous operations, operative time of this revision surgery, amount of intraoperative blood loss, osteotomy method, and fixed segment were collected. The Cobb angles of the main thoracic and lumbar curves, tilt angle of the lowest instrumented vertebra, coronal balance distance(CBD), and coronal pelvic tilt angle were measured on the anteroposterior and lateral full-spine X-rays preoperatively, immediately postoperatively, and at the last follow-up, and the correction rate of CBD was calculated. The 36-Item Short Form Health Survey(SF-36) was used to score all the patients before operation, immediately after operation, and at final follow-up to assess their improvements in the quality of life. The complications of this reoperation and their outcomes were recorded. Results: The age of the first operation of the patients was 8.86±4.14 years (3-15 years), the number of previous operations was 5.29±3.55(2-13), the operative time of this revision was 346.14±64.65min, and the intraoperative blood loss was 1342.86±687.65ml. Asymmetric pedical subtraction osteotomy(PSO) was performed in 6 patients, and multi-segment Ponte osteotomy with internal fixation fusion segment extended was performed in the remaining 1 patient. The CBD was improved to 36.11±15.14mm immediately after surgery from the preoperative 77.23±33.28mm significantly(P<0.05), with a correction rate of (53±3)%, and it was 35.91±14.45mm at final follow-up, with no significant difference from that immediately after surgery(P>0.05). The main thoracic curve, the lowest instrumented vertebra inclination angle, and the coronal pelvic inclination angle were significantly reduced immediately after surgery(P<0.05), and no significant differences were found between those at final follow-up and immediately after surgery, respectively(P>0.05). The lumbar curve was 21.29°±17.77° at preoperation and 30.14°±8.86° at immediately after surgery, the changes were significantly different(P<0.05), and it was 30.14°±8.13° at the last follow-up, not significantly changed from that after surgery(P>0.05). The SF-36 comprehensive score before surgery was 27.29±1.98 points, which improved to 36.86±2.27 points immediately after surgery(P<0.05) and 50.14±3.24 points at final follow-up(P<0.05). Five patients developed postoperative complications such as pleural effusion, cerebrospinal fluid leakage, and lower extremity neuralgia, all of which were completely cured during hospitalization. Conclusions: Revision osteotomy can obtain good correction for patients with severe coronal imbalance after multiple operations for scoliosis, but the surgical risk is high, and perioperative complications need to be closely monitored.