CAJ | 학술논문

目的评价一期后路全脊椎切除治疗严重僵硬脊柱畸形的临床效果和并发症.方法回顾性分析2008年1月至2010年1月接受一期后路全脊椎切除治疗的15例严重脊柱侧后凸患者的临床资料.其中男性4例,女性11例;年龄7～53岁,平均22岁.诊断包括先天性脊柱侧后凸10例,特发性脊柱侧后凸1例,先天性脊柱后凸3例,陈旧性结核性后凸1例.均采用椎弓根螺钉技术,其中初次手术12例,翻修手术3例.通过站立位全脊柱正侧位X线片,测量手术前后冠状面和矢状面节段性Cobb角、躯干偏移以及矢状面平衡情况,同时记录围手术期以及迟发并发症情况.结果平均切除椎体1.8个,其中单椎体8例,2椎体5例,3椎体1例,5椎体1例.手术时间240～450 min,平均331 min;出血量800～3000 ml,平均1453 ml.随访时间3～24个月,平均13个月.冠状面节段性侧凸由术前的111°矫正至51°,末次随访53°,矫形率为54.0%;矢状面节段性后凸由术前的104°矫正至39°,末次随访42°,矫形率为62.5%;躯干偏移术前为19.5 mm,术后18.1mm,末次随访12.4 mm;矢状面平衡术前为20.0 mm,术后-2.0 mm,末次随访-1.1 mm.术中3例发生壁层胸膜撕裂;2例患者术后出现一过性一侧下肢肌力减退,6个月随访时恢复正常;1例出现季肋部束带感.结论一期后路全脊椎切除是治疗严重脊柱畸形的一种有效术式,但对手术技术要求高,应充分重视术中和术后神经系统并发症.
목적 평개일기후로전척추절제치료엄중강경척주기형적림상효과화병발증.방법 회고성분석2008년1월지2010년1월접수일기후로전척추절제치료적15례엄중척주측후철환자적림상자료.기중남성4례,녀성11례;년령7～53세,평균22세.진단포괄선천성척주측후철10례,특발성척주측후철1례,선천성척주후철3례,진구성결핵성후철1례.균채용추궁근라정기술,기중초차수술12례,번수수술3례.통과참립위전척주정측위X선편,측량수술전후관상면화시상면절단성Cobb각、구간편이이급시상면평형정황,동시기록위수술기이급지발병발증정황.결과 평균절제추체1.8개,기중단추체8례,2추체5례,3추체1례,5추체1례.수술시간240～450 min,평균331 min;출혈량800～3000 ml,평균1453 ml.수방시간3～24개월,평균13개월.관상면절단성측철유술전적111°교정지51°,말차수방53°,교형솔위54.0%;시상면절단성후철유술전적104°교정지39°,말차수방42°,교형솔위62.5%;구간편이술전위19.5 mm,술후18.1mm,말차수방12.4 mm;시상면평형술전위20.0 mm,술후-2.0 mm,말차수방-1.1 mm.술중3례발생벽층흉막시렬;2례환자술후출현일과성일측하지기력감퇴,6개월수방시회복정상;1례출현계륵부속대감.결론 일기후로전척추절제시치료엄중척주기형적일충유효술식,단대수술기술요구고,응충분중시술중화술후신경계통병발증.
Objective To evaluate the outcomes and complications of posterior vertebral column resection in the treatment of severe and fixed spinal deformities. Methods From January 2008 to January 2010,15 consecutive cases (4 males, 11 females) of severe and fixed spinal deformities managed by single posterior vertebral column resection with transpedicular instrumentation were investigated retrospectively. The diagnosis included congenital scoliosis in 10 cases, adolescent idiopathic scoliosis in 1 case, congenital kyphosis in 3 cases, tuberculous kyphosis 1 case. Radiograghs were measured to determine the regional coronal and sagittal curve magnitude, and the coronal and sagittal balance preoperatively, postoperatively and at the final follow-up. Operative reports and patient charts were reviewed to record operation time, introoperative blood loss and complications. Results The mean resected vertebrae was 1.8 ( range, 1-5). The mean operation time was 331 min (range, 240-450 min) with an average blood loss of 1453 ml (range, 800-3000 ml). The average follow-up time was 13 months (range, 3-24 months). The regional scoliosis was corrected from 111° to 51°with a correction rate of 54. 0%, and regional kyphosis from 104° to 39° with a correction rate of 62.5%. No obvious loss of correction was noted at the final follow-up. The coronal trunk shift improved from 19. 5 mm preoperatively to 18. 1 mm postoperatively and 12. 4 mm at final follow-up. The sagittal balance improved from 20. 0 mm preoperatively to - 2. 0 mm postoperatively and - 1. 1 mm at the final follow-up. Complications included partial pleural rupture requiring repair in 3 cases, transient muscle weakness of one lower limb after surgery but recovered completely at 6 month follow-up in 2 cases, and tightness of thorax after surgery in one case. Conclusions Posterior vertebral column resection is effective in treatment of severe and rigid spinal deformities. But it is a technique-demanding procedure with higher risks of major neurologic complications.