CAJ | 학술논문

目的分析后路经椎弓根楔形截骨及全脊椎截骨治疗脊柱严重畸形的围手术期并发症.方法 2007年1月至2011年12月,采用后路经椎弓根截骨治疗73例脊柱畸形患者,其中发生至少一种围手术期并发症患者30例,男8例,女22例；年龄8～68岁,平均40.7岁.脊柱畸形包括侧凸10例,侧后凸9例,后凸11例.其中行经椎弓根全脊椎截骨22例,经椎弓根楔形截骨8例.对该30例患者发生的各种围手术期并发症临床资料进行回顾性分析.结果除1例患者术后死于失血导致的失血性休克外,29例患者获得门诊随访,随访时间6～61个月,平均17.2个月.30例(36例次)患者发生围手术期并发症,占同期接受该类手术患者总数的41.1％(30/73).其中发生神经系统并发症16例(16/73,21.9％),包括严重神经功能障碍5例(5/73,6.8％),一过性神经功能障碍11例(11/73,15％)；术后失血相关严重并发症2例(2/73,2.7％),包括出血致失血性休克死亡1例(1/73,1.4％),血肿1例(1/73,1.4％)；硬膜损伤6例(6/73,8.2％),术后脑脊液漏4例(4/73,5.5％)；切口感染4例(4/73,5.5％)；术后胸腔积液4例(4/73,5.5％).结论后路经椎弓根截骨是治疗脊柱畸形的有效手术方法,但常伴发神经损伤、出血、硬膜损伤、切口感染、胸腔积液等一系列并发症,其中神经功能并发症和出血是最主要的并发症.
목적 분석후로경추궁근설형절골급전척추절골치료척주엄중기형적위수술기병발증.방법 2007년1월지2011년12월,채용후로경추궁근절골치료73례척주기형환자,기중발생지소일충위수술기병발증환자30례,남8례,녀22례；년령8～68세,평균40.7세.척주기형포괄측철10례,측후철9례,후철11례.기중행경추궁근전척추절골22례,경추궁근설형절골8례.대해30례환자발생적각충위수술기병발증림상자료진행회고성분석.결과 제1례환자술후사우실혈도치적실혈성휴극외,29례환자획득문진수방,수방시간6～61개월,평균17.2개월.30례(36례차)환자발생위수술기병발증,점동기접수해류수술환자총수적41.1％(30/73).기중발생신경계통병발증16례(16/73,21.9％),포괄엄중신경공능장애5례(5/73,6.8％),일과성신경공능장애11례(11/73,15％)；술후실혈상관엄중병발증2례(2/73,2.7％),포괄출혈치실혈성휴극사망1례(1/73,1.4％),혈종1례(1/73,1.4％)；경막손상6례(6/73,8.2％),술후뇌척액루4례(4/73,5.5％)；절구감염4례(4/73,5.5％)；술후흉강적액4례(4/73,5.5％).결론 후로경추궁근절골시치료척주기형적유효수술방법,단상반발신경손상、출혈、경막손상、절구감염、흉강적액등일계렬병발증,기중신경공능병발증화출혈시최주요적병발증.
Objective To analyze the perioperative complications of posterior transpedicular osteotomy (wedge osteotomy and total vertebral osteotomy) for patients with spinal deformity.Methods From January 2007 to December 2011,73 patients with spinal deformity underwent posterior transpedicular spinal osteotomy (wedge osteotomy and total vertebral osteotomy).Among them,30 patients,including 8 males and 22females,aged from 8 to 68 years (average,40.7 years),presented with at least one perioperative complication.There were 10 cases of scoliosis,9 cases of kyphoscoliosis and 11 cases of kyphosis.Twenty two patients underwent total vertebral osteotomy,and 8 patients underwent wedge osteotomy.A retrospective analysis on perioperative complications of 30 patients was performed.Results Except 1 patient dying of hemorrhagic shock after operation,29 patients were followed up for 6 to 61 months (average,17.2 months).The total perioperative complication rate was 41.1％.Neurological complications occurred in 16 patients (21.9％),bleeding complications in 2 patients (2.7％),dural injury in 6 patients (8.2％),postoperative cerebrospinal fluid leakage in 4 patients (5.5％),wound infection in 4 patients (5.5％) and pleural effusion in 4 patients (5.5％).Conclusion Posterior transpedicular osteotomy is an effective surgical technique for spinal deformity.However,perioperative complications are common,including nerve injury,bleeding,dural injury,wound infection and so on.Among them,nerve injury and bleeding are most common.