中国骨科临床与基础研究杂志
中國骨科臨床與基礎研究雜誌
중국골과림상여기출연구잡지
CHINESE JOURNAL OF CLINICAL AND BASIC ORTHO[AEDIC RESEARCH
2013年
4期
231-234
,共4页
退变性疾病%脊柱侧凸%脊柱融合术%减压术,外科%手术后并发症
退變性疾病%脊柱側凸%脊柱融閤術%減壓術,外科%手術後併髮癥
퇴변성질병%척주측철%척주융합술%감압술,외과%수술후병발증
Degenerative diseases%Scoliosis%Spinal fusion%Decompression,surgical%Postoperative complications
目的探讨成人退行性脊柱侧凸（DDS）手术的临床效果，分析与手术相关的围术期及远期并发症。方法对2000年8月至2011年8月北京协和医院收治的320例DDS手术患者的临床资料进行回顾性分析。采用Oswestry功能障碍指数（ODI）评分及改良Prolo评分评估手术效果，记录患者手术满意度，观察手术相关并发症发生情况。结果随访时间1～8年，平均随访时间4.2年。末次随访患者平均ODI评分为38.2分（25～48分），手术优良率80.9%，手术满意度80.9%。17例（5.3%）患者出现手术相关并发症：围术期并发症包括内固定位置不佳6例（其中3例伴下肢神经症状）、脑卒中1例、脑脊液漏1例、伤口愈合不良3例；远期并发症包括内固定松动2例、邻近节段退行性变4例。结论由于成人DDS患者多为高龄，椎体存在节段性旋转畸形，因此手术相关并发症发生率较高。术前认真查体、仔细分析影像学资料、充分结合患者临床症状，有助于选择合理的手术方案，取得满意的临床效果，同时预防手术相关并发症的发生。
目的探討成人退行性脊柱側凸（DDS）手術的臨床效果，分析與手術相關的圍術期及遠期併髮癥。方法對2000年8月至2011年8月北京協和醫院收治的320例DDS手術患者的臨床資料進行迴顧性分析。採用Oswestry功能障礙指數（ODI）評分及改良Prolo評分評估手術效果，記錄患者手術滿意度，觀察手術相關併髮癥髮生情況。結果隨訪時間1～8年，平均隨訪時間4.2年。末次隨訪患者平均ODI評分為38.2分（25～48分），手術優良率80.9%，手術滿意度80.9%。17例（5.3%）患者齣現手術相關併髮癥：圍術期併髮癥包括內固定位置不佳6例（其中3例伴下肢神經癥狀）、腦卒中1例、腦脊液漏1例、傷口愈閤不良3例；遠期併髮癥包括內固定鬆動2例、鄰近節段退行性變4例。結論由于成人DDS患者多為高齡，椎體存在節段性鏇轉畸形，因此手術相關併髮癥髮生率較高。術前認真查體、仔細分析影像學資料、充分結閤患者臨床癥狀，有助于選擇閤理的手術方案，取得滿意的臨床效果，同時預防手術相關併髮癥的髮生。
목적탐토성인퇴행성척주측철（DDS）수술적림상효과，분석여수술상관적위술기급원기병발증。방법대2000년8월지2011년8월북경협화의원수치적320례DDS수술환자적림상자료진행회고성분석。채용Oswestry공능장애지수（ODI）평분급개량Prolo평분평고수술효과，기록환자수술만의도，관찰수술상관병발증발생정황。결과수방시간1～8년，평균수방시간4.2년。말차수방환자평균ODI평분위38.2분（25～48분），수술우량솔80.9%，수술만의도80.9%。17례（5.3%）환자출현수술상관병발증：위술기병발증포괄내고정위치불가6례（기중3례반하지신경증상）、뇌졸중1례、뇌척액루1례、상구유합불량3례；원기병발증포괄내고정송동2례、린근절단퇴행성변4례。결론유우성인DDS환자다위고령，추체존재절단성선전기형，인차수술상관병발증발생솔교고。술전인진사체、자세분석영상학자료、충분결합환자림상증상，유조우선택합리적수술방안，취득만의적림상효과，동시예방수술상관병발증적발생。
Objective To explore clinical effects and analyze the perioperative and long-term complications associated with surgical treatment for adult de-novo degenerative scoliosis (DDS). Methods Clinical data of 320 DDS patients underwent operations in Peking Union Medical College Hospital from August 2000 to August 2011 were retrospectively reviewed. Clinical efficacy was evaluated by Oswestry disability index (ODI) and modified Prolo scoring, degree of satisfaction of patients was recorded, and the complications related to the operations were observed. Results All patients were followed up from 1 to 8 years (average, 4.2 years). At the final follow-up, average ODI score was 38.2 (25-48), the excellent and good rate of modified Prolo scoring was 80.9%, degree of satisfaction of patients was 80.9%. Complications associated with surgical treatment occurred in 17 patients (5.3%), including perioperative complications (poor location of pedicle screws in 6 cases, stroke in 1 case, cerebrospinal fluid leakage in 1 case and poor wound healing in 3 cases) and long-term complications (internal fixation loosening in 2 cases and adjacent segment degeneration in 4 cases). Conclusions The prevalence of complications associated with surgical treatment for adult DDS is relatively high because most of DDS patients were elderly, and there existed segmental rotatory deformity in vertebral bodies. So it is quite important for the surgeons to comprehensively analyze the neurological signs, imaging data and clinical symptoms before the surgry, so as to choose appropriate surgical program to prevent surgery-related complications and get satisfied effects.
