CAJ | 학술논문

目的探讨一期后路截骨矫形术治疗重度脊柱畸形术后并发症原因及处理.方法回顾性分析2006年9月至2013年5月,采用一期后路截骨矫形内固定术治疗147例重度脊柱畸形患者资料,其中17例术后发生病发症,男5例,女12例;年龄14～51岁,平均22.6岁;先天性脊柱侧凸11例,先天性脊柱后凸4例,先天性脊柱侧后凸2例;术前主弯侧凸Cobb角85°～160°,平均109°;后凸Cobb角65°～152°,平均104°.术前2例患者有神经症状,美国脊髓损伤协会ASIA分级均为D级.手术均采用椎弓根钉棒系统矫形固定,其中采用Smith-Petersen截骨术2例、经椎弓根截骨术11例、全脊椎截骨术4例.结果 17例出现并发症,并发症发生率为11.6％(17/147).其中椎弓根螺钉置入椎管2例、截骨端合拢压迫及牵拉神经2例、截骨处残留骨块压迫神经1例、急性脊髓损伤2例、感染2例、断棒及脱帽3例、肠系膜上动脉综合征5例.术后7例发生神经系统并发症,其中2例由术前ASIA分级D级变为C级,5例由神经功能正常变为C级2例、D级3例.采用再次手术调整钉棒、应用甲基泼尼松龙、神经营养药物、取出内固定、抗感染、翻修换棒及对症处理,15例完全恢复,2例好转.结论严重脊柱畸形一期后路截骨矫形术后会出现神经系统及断棒、脱帽、肠系膜上动脉综合征等并发症.为避免发生并发症,术中应提高椎弓根钉置入的准确性,合理安置螺钉数量及位置,截骨端牵拉加压应适度,并彻底咬除截骨端骨块,术后密切观察肢体感觉及运动变化情况,及时手术探查并解除神经致压因素,同时给予激素冲击、神经营养等药物,术后早期需佩戴合适支具,避免暴力撞击手术部位.
목적 탐토일기후로절골교형술치료중도척주기형술후병발증원인급처리.방법 회고성분석2006년9월지2013년5월,채용일기후로절골교형내고정술치료147례중도척주기형환자자료,기중17례술후발생병발증,남5례,녀12례;년령14～51세,평균22.6세;선천성척주측철11례,선천성척주후철4례,선천성척주측후철2례;술전주만측철Cobb각85°～160°,평균109°;후철Cobb각65°～152°,평균104°.술전2례환자유신경증상,미국척수손상협회ASIA분급균위D급.수술균채용추궁근정봉계통교형고정,기중채용Smith-Petersen절골술2례、경추궁근절골술11례、전척추절골술4례.결과 17례출현병발증,병발증발생솔위11.6％(17/147).기중추궁근라정치입추관2례、절골단합롱압박급견랍신경2례、절골처잔류골괴압박신경1례、급성척수손상2례、감염2례、단봉급탈모3례、장계막상동맥종합정5례.술후7례발생신경계통병발증,기중2례유술전ASIA분급D급변위C급,5례유신경공능정상변위C급2례、D급3례.채용재차수술조정정봉、응용갑기발니송룡、신경영양약물、취출내고정、항감염、번수환봉급대증처리,15례완전회복,2례호전.결론 엄중척주기형일기후로절골교형술후회출현신경계통급단봉、탈모、장계막상동맥종합정등병발증.위피면발생병발증,술중응제고추궁근정치입적준학성,합리안치라정수량급위치,절골단견랍가압응괄도,병철저교제절골단골괴,술후밀절관찰지체감각급운동변화정황,급시수술탐사병해제신경치압인소,동시급여격소충격、신경영양등약물,술후조기수패대합괄지구,피면폭력당격수술부위.
Objective To analyze the cause and treatment of the postoperative complications using one-stage posterior spinal osteotomy in the treatment of severe spinal deformity.Methods From September 2006 to May 2013,17 patients with severe spinal deformity (congenital scoliosis in 11 cases,congenital kyphosis in 4 cases,and congenital kyphoscoliosis in 2 cases) underwent one-stage posterior spinal osteotomy,including 5 males and 12 females with an average age of 22.6 (14-51) years.The preoperative mean coronal Cobb angle was 109° (85°-160°) while the mean sagittal Cobb angle was 104° (65°-152°).Two patients had neurological symptoms preoperatively whose spinal cord function was D,evaluated by ASIA classification.All patients were treated with pedicle subtration osteotomy and pedicle screw internal fixation,which SPO osteotomy 2 cases,PSO osteotomy 11 cases,VCR osteotomy 4 cases.Results There were 17 cases of complications in 147 patients,the complication rate was 11.6％(17/147).The causes were as followed,screw malposition in 2 cases,compromised by close of resected areas in 2 case,residual bone compression in 1 case,acute spinal cord injury in 2 cases,infection in 2 cases,broken stick or loosen hat in 3 cases,and superior mesenteric artery syndrome in 5 cases.Postoperative neurological complications occurred in 7 cases.Two cases with preoperative ASIA D became ASIA C,5 cases with normal nerve function became ASIA C in 2 cases and ASIA D in 3 cases.After surgical exploration,given Methylprednisolone and neurotrophic drugs,removal or changing of the internal fixation,anti-infection and symptomatic treatment,15 cases recovered completely and 2 cases improved partially.Conclusion One-stage posterior spinal osteotomy for severe spinal deformity is technical demanding and risky,and the postoperative complications are common.Appropriate operative procedure,close observation of sensation and motor function,timely surgical exploration and nerve decompression,and early brace wear are all required.