CAJ | 학술논문

背景：椎体环截是近年来提出较多的脊柱矫形概念，因其操作技巧要求高，难度大，并发症多，既往相关文献报道角度各不相同，很多研究者注重并发症分析，究其原因与操作步骤及方式有关。目的：分析单纯后路椎体环截及螺钉置入治疗重度脊柱畸形的疗效和并发症。方法：回顾性分析48例单纯后路椎体环截及螺钉置入治疗重度脊柱畸形患者的临床资料，平均切除椎体1.6个，随访15-64个月，分析所有患者治疗前、治疗后及最后一次随访时Cobb角(冠状面及矢状面)，并对手术相关并发症进行分析。结果与结论：纳入的脊柱畸形患者共分5类，其中脊柱侧后凸畸形11例，重度侧凸畸形20例，先天性脊柱畸形4例，球状后凸畸形3例，角状后凸畸形10例。所有患者治疗前平均冠状面畸形角度由84°矫正到35°，总的矫正率达到54%。治疗前平均矢状面畸形角度由90°矫正到42°，矢状面 Cobb 平均减小了48°。手术时间平均545 min(204-1355 min)，术中平均估计失血量1610 mL(50-8244 mL)，平均失血量达65%。31例治疗后出现并发症，其中13例术中神经功能异常(通过电生理监测及唤醒实验发现)，及时处理后患者未出现永久性神经功能障碍。提示单纯后路椎体环截及螺钉置入治疗重度脊柱畸形效果良好，但并发症高，操作难度较大。
배경：추체배절시근년래제출교다적척주교형개념，인기조작기교요구고，난도대，병발증다，기왕상관문헌보도각도각불상동，흔다연구자주중병발증분석，구기원인여조작보취급방식유관。목적：분석단순후로추체배절급라정치입치료중도척주기형적료효화병발증。방법：회고성분석48례단순후로추체배절급라정치입치료중도척주기형환자적림상자료，평균절제추체1.6개，수방15-64개월，분석소유환자치료전、치료후급최후일차수방시Cobb각(관상면급시상면)，병대수술상관병발증진행분석。결과여결론：납입적척주기형환자공분5류，기중척주측후철기형11례，중도측철기형20례，선천성척주기형4례，구상후철기형3례，각상후철기형10례。소유환자치료전평균관상면기형각도유84°교정도35°，총적교정솔체도54%。치료전평균시상면기형각도유90°교정도42°，시상면 Cobb 평균감소료48°。수술시간평균545 min(204-1355 min)，술중평균고계실혈량1610 mL(50-8244 mL)，평균실혈량체65%。31례치료후출현병발증，기중13례술중신경공능이상(통과전생리감측급환성실험발현)，급시처리후환자미출현영구성신경공능장애。제시단순후로추체배절급라정치입치료중도척주기형효과량호，단병발증고，조작난도교대。
BACKGROUND:Vertebral column resection is the frequently mentioned spinal orthopaedic concept. Due to the high requirement of the operation skil , difficulty and more complications, the previous studies have reported from different aspects, and many researchers have focused on the analysis of complications, that may be related with the procedure and manner. OBJECTIVE:To analyze the efficacy and complications of posterior vertebral column resection combined with titanium screw rod fixation for the treatment of severe spinal deformity. METHODS:We retrospectively analyzed 48 patients with severe spinal deformity who treated with posterior vertebral column resection and titanium screw rod fixation, with an average removal of 1.6 vertebral. The patients were fol owed-up for 15-64 months. The Cobb angle (coronal plane and sagittal plane) of the patients before treatment, after treatment and in the final fol ow-up was analyzed, and the relative complications of the surgery were analyzed. RESULTS AND CONCLUSION:The patients with spinal deformity were divided into five categories, included kyphoscoliosis (n=11), severe scoliosis (n=20), congenital spinal deformity (n=4), spherical kyphosis (n=3), and angular kyphosis (n=10). The average coronal plane deformity angle of the patients was corrected from 84° preoperation to 35° postoperation, with the total correction rate of 54%. The average sagittal plane deformity angle was corrected from 90° preoperation to 42° postoperation, and the sagittal plane Cobb angle was decreased for 48°. The mean operation time was 545 minutes (204-1 355 minutes), the intraoperative blood loss was 1 610 mL (50-8 244 mL), and the average blood loss was 65%. After treatment, 31 cases had complications, including 13 cases of intraoperative neurological dysfunction (observed through electrophysiological monitoring and wake), permanent neurological dysfunction did not occur after timely treatment. The posterior vertebral column resection and titanium screw rod fixation can obtain better effect in the treatment of severe spinal deformity, but the procedure has high complications and is difficult for operation.