经后路全椎骨切除术治疗僵硬脊柱畸形及并发症分析  

Posterior route total vertebral resection for the correction of rigid spinal deformity and complications of analysis

作　　者：解京明[1] 王迎松[1] 张颖[1] 鲁宁[1] 陈鸿[1] 曹锦[1] 张漾杰[1] 

机构地区：[1]昆明医学院第二附属医院骨科,云南昆明650101

出　　处：《颈腰痛杂志》2009年第1期8-12,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨采用单纯经后路全椎骨切除技术治疗僵硬性脊柱后凸畸形的手术技术,分析围手术期并发症的发生和预防。方法回顾性分析2004年10月-2006年7月,采用单纯后路全椎骨切除技术治疗的12例僵硬的脊柱畸形患者。术中完全切除畸形顶椎椎体和相邻椎间盘结构,通过椎弓根钉棒系统综合运用加压-撑开-开放-闭合矫形力获得矫形;椎间以钛网或打压植骨融合。结果所有患者均获得满意的矢状面和冠状面躯干平衡。术中发生胸膜穿破6例;2例于术中发生凝血机制异常;术后1例有切口下浅层感染。随访时间12～24月,无内固定松动或断裂发生,遗留后凸及侧凸角度与术后相比平均变化小于5°。结论僵硬性脊柱畸形矫形手术中最重要的是避免脊髓和腰段神经根损伤。经后路全椎骨切除术能完整显露矫形区域的硬膜囊以直视下保护,且脊髓对一定范围的缩短、成角、旋转等各种位移有耐受性;控制性降压和自体红细胞回输技术能有效减少出血量和输入异体库存血量;术后需关注胸腔并发症。Objective To discuss the operative technique of posterior route total vertebral resection in treatment of rigid spinal deformities,and analyze the incidence and prevention of complications occurred in perioperative period. Methods A retrospective study was made in 12 cases with stiffness deformity,included of kyphosis or kyphoscoliosis,treated by single posterior route total vertebral resection. All cases were performed posterior route total vertebral and adjacent, intervertebral disc resection on the apex vertebra. Based on the application of trans-pedicular fixations,compression,distraction,opening and closing forces were combined to correct the deformity. Titanic mesh or impacted bone graft were used in interbody fusion. Results The preoperative deformities in the sagittal and coronal plane were corrected to balance. There were six pleura injuries and two blood coagulation disorder during operative procedure. One subcutaneous infection was treated by drainage postoperation. At the final 12-24 months followed-up,no instrumentation failure was observed and deformities correction was showing a loss of less than 5°. Conclusion Try to avoid injury of the spinal cord and lumbar nerve roots must be pay close attention in the operative procedure of correction rigid spinal deformity. Posterior route total vertebral resection creates a chance to completely reveal the dura mate of spinal cord and then preserve it under sights. Meanwhile the spinal cord could tolerate the offset as shorten,angulation and rotation in a limited extent. Controlled hypotension combined with autotransfusion can remarkable decrease the need for homologous transfusion.Postoperative pleural effusion need be appropriate management.

关 键 词：脊柱 畸形 全椎骨切除 并发症 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]