CAJ | 학술논문

目的探讨应用I期后路全脊椎切除治疗重度胸腰椎畸形的神经系统并发症,并分析相关危险因素.方法 2000年2月-2010年9月接受I期后路全脊椎切除治疗的重度胸腰椎畸形患者67例,男29例,女38例;年龄14～62岁,平均31.4岁.其中青少年(年龄<18岁)21例,成人(年龄≥18岁)46例.侧凸畸形11例,平均冠状面主弯Cobb角90.4°;侧后凸畸形25例,冠状面主弯Cobb角94.5°,后凸角度平均65.5°;角状后凸畸形28例,平均后凸角74.3°;圆弧状后凸3例,平均后凸角91.1°.初次手术患者59例,翻修患者8例.采用主弯区顶椎全脊椎切除,全节段椎弓根螺钉内固定矫形和360°植骨融合术,统计神经系统并发症的发生情况.结果平均随访时间14个月(3～69个月),出现神经系统并发症者共8例(11.9%),其中严重神经并发症3例,发生率4.5%,包括1例大量失血血容量灌注不足导致完全性脊髓损伤.轻度神经并发症患者5例,发牛率7.5%.胸椎全脊椎切除的神经损伤发生率要明显高于腰椎(P<0.05).多个椎体切除的并发症发牛率显著增加(P<0.05).术前已经伴有或者不伴有神经损害表现患者的神经并发症发生率分别为33.3%和7.3%(P<0.05),翻修手术的并发症发生率明显增加(P<0.05).差异虽无统计学意义(P>0.05),但出现神经系统并发症的8例患者术前均合并有严重的后凸畸形(>60.).结论 I期后路全脊椎切除是外科治疗重度胸腰椎畸形有效手术方式,但神经并发症应引起关注.相关神经损伤危险因素包括术中操作不当、大量失血、术前已经有神经受损表现、胸段截骨、多个椎体切除、翻修手术和严重后凸.
목적 탐토응용I기후로전척추절제치료중도흉요추기형적신경계통병발증,병분석상관위험인소.방법 2000년2월-2010년9월접수I기후로전척추절제치료적중도흉요추기형환자67례,남29례,녀38례;년령14～62세,평균31.4세.기중청소년(년령<18세)21례,성인(년령≥18세)46례.측철기형11례,평균관상면주만Cobb각90.4°;측후철기형25례,관상면주만Cobb각94.5°,후철각도평균65.5°;각상후철기형28례,평균후철각74.3°;원호상후철3례,평균후철각91.1°.초차수술환자59례,번수환자8례.채용주만구정추전척추절제,전절단추궁근라정내고정교형화360°식골융합술,통계신경계통병발증적발생정황.결과 평균수방시간14개월(3～69개월),출현신경계통병발증자공8례(11.9%),기중엄중신경병발증3례,발생솔4.5%,포괄1례대량실혈혈용량관주불족도치완전성척수손상.경도신경병발증환자5례,발우솔7.5%.흉추전척추절제적신경손상발생솔요명현고우요추(P<0.05).다개추체절제적병발증발우솔현저증가(P<0.05).술전이경반유혹자불반유신경손해표현환자적신경병발증발생솔분별위33.3%화7.3%(P<0.05),번수수술적병발증발생솔명현증가(P<0.05).차이수무통계학의의(P>0.05),단출현신경계통병발증적8례환자술전균합병유엄중적후철기형(>60.).결론 I기후로전척추절제시외과치료중도흉요추기형유효수술방식,단신경병발증응인기관주.상관신경손상위험인소포괄술중조작불당、대량실혈、술전이경유신경수손표현、흉단절골、다개추체절제、번수수술화엄중후철.
Objective To analyze the neurological complications in treatment of severe thoracolumbar spinal deformity with one stage posterior vertebral column resection (pVCR) and discuss the related risk factors. Methods There were 67 patients with severe thoracolumbar spinal deformity who underwent one-stage pVCR from February 2000 to September 2010.There were 29 males and 38 females at an average age of 31.4 years old(range,14-62 years).There were 21 patients at age less than 18 years old and 46 at age more than 18 years old.Patients were divided into four pathological types:severe scoliosis group(n=11,mean Cobb angle 90.4°),kyphoscoliosis group(n=25,mean scoliosis 94.5°,and mean kyphosis 65.5°),angular kyphosis group(n=28,mean kyphosis 74.3°)and global kyphosis group(n=3,mean kyphosis 91.1°).of all the patients,59 patients underwent primary surgery and eight underwent revision surgery.Surgical methods included posterior apex vertebral column resection,segemental pedicle screw fixation and correction as well as 360° bone fusion.Neurological complication was statistically analyzed. Results The average follow-up was 14 months (range,3-69 months),which showed severe neurologic complication in eight patients(11.9%)after surgery.Severe neurologic complication occurred in three patients (4.5%),among whom one patient presented delayed complete paraplegia 23 hours after surgery.Five patients had mild neurologic deficits(7.5%),the incidence of which was higher than 23.1%for thoracic osteotomy (P<0.05).Multilevel pVCR had high rate of neurological complications (P<0.05).The incidence rate was 33.3% for patients with preoperative neurologic compromise and 7.3%for patients mthom preoperative neuroiogic compromise (P<0.05).The incidence rate was increased in the revision surgery (P<0.05).Eight patients with neurological deficits had kyphotic angle of raore than 60°although there was no statistical difference (P>0.05). Conclusions pVCR is an effective surgical method for the correction of severe thoracolumbar spinal deformity.The neurological complications,however,should be paid attention to the surgeons.The risk factors for neurologic complications include improper manipulation,massive blood losing,preoperative neurologic compromise,osteotomy at thoracic rein,multi-level vertebrectomy,revision surgery and severe kyphosis.