CAJ | 학술논문

目的探讨后路全脊椎截骨治疗严重僵硬性先天性脊柱畸形的神经系统并发症及其危险因素.方法收集2007年6月至2012年11月在第四军医大学西京医院接受后路全脊椎截骨治疗的88例严重僵硬性先天性脊柱畸形患者的临床资料,男性39例,女性49例,年龄6～46岁,平均16.9岁.测量患者术前、术后及随访时Cobb角、平衡情况,记录手术情况、神经系统并发症及随访情况等.对患者的年龄、Cobb角、手术时间、体重指数、肺功能、出血比、截骨部位、固定椎体数、切除椎体数、使用cage/钛网情况、术前神经功能状况、畸形类型、合并椎管内畸形情况进行单因素分析,对有意义的因素进行多因素Logistic回归分析.结果所有患者平均随访42个月(19 ～ 83个月),平均切除椎体1.3个(1～3个),平均手术时间502 min(165 ～ 880 min),平均出血量2 238 ml(100 ～11 500 ml),平均出血比69.3％(9％～299％).冠状位Cobb角由术前平均93.6°矫正至22.2°,末次随访22.9°,矫形率76.8％.冠状位失衡(绝对值)由术前平均2.5 cm减少至1.3 cm.矢状位Cobb角由术前平均88.2°矫正至28.7°,末次随访29.2°,矢状位Cobb角平均减少59.0°.矢状位失衡(绝对值)由术前平均3.1 cm减少至1.2 cm.发生神经系统并发症12例(13.6％).手术时间≥480 min、肺功能异常、出血比＞50％、T7～T9截骨及术前神经功能异常患者神经系统并发症发生率较高(P=0.046,0.000,0.000,0.033,0.043).结论后路全脊椎截骨治疗严重脊柱畸形疗效显著,肺功能异常、出血比＞50％是发生神经系统并发症的高危因素.
목적 탐토후로전척추절골치료엄중강경성선천성척주기형적신경계통병발증급기위험인소.방법 수집2007년6월지2012년11월재제사군의대학서경의원접수후로전척추절골치료적88례엄중강경성선천성척주기형환자적림상자료,남성39례,녀성49례,년령6～46세,평균16.9세.측량환자술전、술후급수방시Cobb각、평형정황,기록수술정황、신경계통병발증급수방정황등.대환자적년령、Cobb각、수술시간、체중지수、폐공능、출혈비、절골부위、고정추체수、절제추체수、사용cage/태망정황、술전신경공능상황、기형류형、합병추관내기형정황진행단인소분석,대유의의적인소진행다인소Logistic회귀분석.결과 소유환자평균수방42개월(19 ～ 83개월),평균절제추체1.3개(1～3개),평균수술시간502 min(165 ～ 880 min),평균출혈량2 238 ml(100 ～11 500 ml),평균출혈비69.3％(9％～299％).관상위Cobb각유술전평균93.6°교정지22.2°,말차수방22.9°,교형솔76.8％.관상위실형(절대치)유술전평균2.5 cm감소지1.3 cm.시상위Cobb각유술전평균88.2°교정지28.7°,말차수방29.2°,시상위Cobb각평균감소59.0°.시상위실형(절대치)유술전평균3.1 cm감소지1.2 cm.발생신경계통병발증12례(13.6％).수술시간≥480 min、폐공능이상、출혈비＞50％、T7～T9절골급술전신경공능이상환자신경계통병발증발생솔교고(P=0.046,0.000,0.000,0.033,0.043).결론 후로전척추절골치료엄중척주기형료효현저,폐공능이상、출혈비＞50％시발생신경계통병발증적고위인소.
Objective To analyze the risk factors of neurological complications of posterior vertebral column resection in the treatment of severe rigid congenital spinal deformities.Methods The clinical data of 88 patients with severe rigid congenital spinal deformities who underwent PVCR in Department Of Orthopaedics,Xijing Hospital,Fourth Military Medical University from June 2007 to November 2012 were collected.There were 39 males and 49 females at the average age of 16.9 years (range 6-46 years).To measure the Cobb angle and balance at preoperative,postoperative and follow up,and to record the operation report,neurological complications and at follow up.The relevant factors of neurological complications were analyzed by one-way analysis,including:age,Cobb angle,operation time,body mass index,pulmonary function,blood volume loss,resection level,number of vertebrae fixed,number of vertebrae resected,usage of cage or titanium mesh,preoperative neurologic function,the type of deformity and combination of spinal canal deformity,and further analyzed by multiariable Logistic regression analysis.Results The average follow up was 42 months (range 19 to 83 months).The number of resected vertebrae average 1.3 (range 1 to 3),operative time average 502.4 min(range 165.0 to 880.0 min),estimate blood loss average 2 238 ml(range 100 to 11 500 ml) for an average 69.3％ blood volume loss (range 9％ to 299％).The average preoperative major coronal curve of 93.6° corrected to 22.2°,at the final follow-up,the coronal curve was 22.2° with a correction of 76.8％.The average preoperative coronal imbalance (absolute value) was 2.5 cm decreasing to 1.3 cm at the final follow-up.The average preoperative major sagittal curve of 88.2° corrected to 28.7°,at the final follow-up,the sagittal curve was 29.2°,average decrease in kyphosis of 59.0°.The average preoperative sagittal imbalance (absolute value) was 3.1 cm decreasing to 1.2 cm at the final followup.There were 12 patients (13.6％) developed a neurological complications.High rate of neurological complications was occurred in patients with operative time greater than 480 min,pulmonary dysfunction,blood volume loss greater than 50％,T7-T9 osteotomy and preoperative neurologic compromise (P =0.046,0.000,0.000,0.033,0.043).Conclusions Posterior vertebral column resection can achieve satisfactory efficacy in treatment of severe spinal deformities.Pulmonary dysfunction and blood volume loss greater than 50％ were significant risk factors of neurological complications.