CAJ | 학술논문

目的回顾退行性脊柱侧凸后路矫形术后的远期临床效果,分析晚期并发症的发生原因,探讨合理的应对措施.方法回顾1997年9月至2002年9月,采用后路椎问融合器结合经椎弓根螺钉治疗退行性脊柱侧凸35例.按照Oswestry功能障碍指数(ODI)评价临床效果,影像学检查评价术后融合节段以及邻近节段病变,测量侧凸冠状位Cobb角、腰前凸角,脊柱冠状面平衡,并分析融合范围、脊柱力线与远期并发症的关系.结果术后ODI为17.8～62.2(平均34.7),患者对手术的主观满意率为71.4%.13例患者发生远期并发症,发生率为37.1%,10例出现临床症状,6例进行翻修手术,4例拒绝再次手术.远期并发症包括:近端交界区侧凸4例、近端交界区后凸4例、近端椎体压缩骨折1例、融合区假关节形成1例、远端椎管狭窄2例,螺钉松动1例.交界性后凸与脊柱力线异常无明显关系,融合至L1及以下邻近节段病变发生率(9/18)明显高于融合至T12以上(4/17).结论退行性脊柱侧凸后路矫形远期并发症较高,术前应仔细评价脊柱力线情况,为减少远期近端交界性侧凸,近端可融合至T12以上.
목적 회고퇴행성척주측철후로교형술후적원기림상효과,분석만기병발증적발생원인,탐토합리적응대조시.방법 회고1997년9월지2002년9월,채용후로추문융합기결합경추궁근라정치료퇴행성척주측철35례.안조Oswestry공능장애지수(ODI)평개림상효과,영상학검사평개술후융합절단이급린근절단병변,측량측철관상위Cobb각、요전철각,척주관상면평형,병분석융합범위、척주력선여원기병발증적관계.결과 술후ODI위17.8～62.2(평균34.7),환자대수술적주관만의솔위71.4%.13례환자발생원기병발증,발생솔위37.1%,10례출현림상증상,6례진행번수수술,4례거절재차수술.원기병발증포괄:근단교계구측철4례、근단교계구후철4례、근단추체압축골절1례、융합구가관절형성1례、원단추관협착2례,라정송동1례.교계성후철여척주력선이상무명현관계,융합지L1급이하린근절단병변발생솔(9/18)명현고우융합지T12이상(4/17).결론 퇴행성척주측철후로교형원기병발증교고,술전응자세평개척주력선정황,위감소원기근단교계성측철,근단가융합지T12이상.
Objective To evaluate the clinical outcome of posterior corrective operation for degenerative scoliosis and analyze the possible reasons for its late complications and their proper management.Methods Thirty-five patients with degenerative scoliosis,who were treated by posterior pedicle screw fixation and interbody fusion with cage implantation from September 1997 to September 2002,were reviewed.Their clinical outcomes were determined according to Oswestry Disability Index(ODI).The fusion area and its adjacent segments were evaluated through radiographic measurements of coronal Cobb angle,lumbar lordosis and coronal balance of the spine.The association of late complications,spinal alignment,and range of fusion was analyzed.Results At final follow-up,ODl was 17.8-62.2(average 34.7).Late complications occurred in 13 patients,accounting for 37.1%.Among the 13 cases,10 were symptomatic and 6 received revision surgery.The late complications were proximal junctional seoliosis in 4 patients,proximal junetional kyphosis in 4 patients,proximal compressed vertebral fracture in 1 patient,pseudarthrosis in 1 patient,pedicle screw loosening in 1 patient,and distal segment degeneration in 1 patient.Junctional kyphosis had no obvious relationship with abnormality of spinal alignment.Adjacent segment degeneration occurred more commonly in the cases with the proximal uhimate vertebra below L1(9/18)than above T12(4/17).Conclusions The rate of late complications is relatively high after posterior corrective operation for degenerative scoliosis.Spinal alignment should be evaluated carefully in preoperative planning.The proximal ultimate vertebra should be extended to the level above T12 to avoid late complications.