CAJ | 학술논문

目的回顾性分析一期手术治疗合并脊髓纵裂的先天性脊柱侧凸的安全性和有效性.方法 2007年1月至2010年12月行一期手术治疗合并脊髓纵裂的先天性脊柱侧凸患者38例;其中男性13例、女性25例,平均年龄(15±6)岁.38例患者中,合并Ⅰ型脊髓纵裂12例、Ⅱ型脊髓纵裂26例.对合并Ⅰ型脊髓纵裂患者,矫形前先切除骨性纵隔;对合并Ⅱ型脊髓纵裂患者直接行脊柱畸形矫形,脊髓纵裂不予处理.以门诊形式随访,入选患者随访至少两年.患者手术前后及末次随访影像学资料比较采用配对t检验,而对Ⅰ型与Ⅱ型脊髓纵裂组间的影像学资料比较采用成组设计资料t检验.结果随访时间26～68个月,平均(4l±13)个月.手术时间105～ 780 min,平均(491±152) min;术中失血量1 000～8 000 ml,平均(1 932±1 516) ml.冠状面Cobb角由术前平均(70±26)°矫正到术后平均(32±16)°;末次随访时平均(33±17)°;术后及末次随访平均矫正率分别是(57±18)％和(54±20)％.矢状面Cobb角由术前平均(43 ±31)°矫正到术后平均(26±l6)°;末次随访时平均(27±15)°.本组病例总体并发症为2例(5.3％):术后即刻暂时性神经损害症状加重1例(2.6％),30个月恢复至术前水平,末次随访症状无进一步改善;脑脊液漏1例(2.6％).无瘫痪及永久性神经损害并发症.结论一期手术治疗合并脊髓纵裂的先天性脊柱侧凸安全有效,没有增加术后及随访期内神经并发症.
목적 회고성분석일기수술치료합병척수종렬적선천성척주측철적안전성화유효성.방법 2007년1월지2010년12월행일기수술치료합병척수종렬적선천성척주측철환자38례;기중남성13례、녀성25례,평균년령(15±6)세.38례환자중,합병Ⅰ형척수종렬12례、Ⅱ형척수종렬26례.대합병Ⅰ형척수종렬환자,교형전선절제골성종격;대합병Ⅱ형척수종렬환자직접행척주기형교형,척수종렬불여처리.이문진형식수방,입선환자수방지소량년.환자수술전후급말차수방영상학자료비교채용배대t검험,이대Ⅰ형여Ⅱ형척수종렬조간적영상학자료비교채용성조설계자료t검험.결과 수방시간26～68개월,평균(4l±13)개월.수술시간105～ 780 min,평균(491±152) min;술중실혈량1 000～8 000 ml,평균(1 932±1 516) ml.관상면Cobb각유술전평균(70±26)°교정도술후평균(32±16)°;말차수방시평균(33±17)°;술후급말차수방평균교정솔분별시(57±18)％화(54±20)％.시상면Cobb각유술전평균(43 ±31)°교정도술후평균(26±l6)°;말차수방시평균(27±15)°.본조병례총체병발증위2례(5.3％):술후즉각잠시성신경손해증상가중1례(2.6％),30개월회복지술전수평,말차수방증상무진일보개선;뇌척액루1례(2.6％).무탄탄급영구성신경손해병발증.결론 일기수술치료합병척수종렬적선천성척주측철안전유효,몰유증가술후급수방기내신경병발증.
Objective To investigate the clinical results of one stage surgical treatment in congenital scoliosis (CS) patients associated with split cord malformation (SCM).Methods Between January 2007 and December 2010,50 patients underwent one stage surgical treatment for CS associated with SCM.Among of them,38 patients (13 male and 25 female) with an average age of (15 ±6) years,who were followed up in the clinic at least 2 years longer,were include in the study.There were 12 patients with Type Ⅰ SCM and 26 patients with Type Ⅱ SCM Pre-operative,post-operative and the follow-up imaging data were collected and compared by paired t-test,while imaging data between Type Ⅰ SCM group and Type Ⅱ SCM group were compared by group t-test.Bony spur was first resected to the Type Ⅰ SCM while nothing was done to the Type Ⅱ SCM.Then,all patients were followed by posterior corrective procedure in one stage.Meanwhile,duraplasty were only applied in 5 patients whose dural cleft were more than 1 cm longer.Results The average follow-up was 41 ± 13 months (range,26--68 months).The average operation time was 491 ± 152 minutes (range,105-780 minutes) and the average blood loss was (1 933 ±1 516) ml (range,1 000-8 000 ml).The mean major coronal curve was corrected from 70° ± 26° preoperatively to 312° ± 16° postoperatively with a correction rate of 57％ ± 18％,and 33° ± 17°at the final follow-up with a correction rate of 54％ ± 20％.The mean major sagittal curve was corrected from 43° ±31° to 26° ± 16°,and 27° ± 15°at the final follow-up.The postoperative complication occurred in 2 patients (5.3％) with Type Ⅰ SCM,including neurological deterioration in 1 patient (2.6％) and cerebrospinal fluid leakage in 1 patient (2.6％).There were no paralysis and other serious complications.The patients who suffered from neurological deterioration recovered to the preoperative neurological status at 30 months postoperatively and no further improvement at the final follow-up.Conclusion It is safe and efficient to treat the CS associated with SCM by one stage surgery without increasing the risk of neurological complications postoperatively.