脊柱侧凸三维矫形并发症的临床分析  

Clinical analysis of complications of three-dimensional correction for scoliosis

作　　者：张宏其[1] 王昱翔[1] 郭超峰[1] 刘少华[1] 唐明星[1] 刘金洋[1] 吴建煌[1] 陈静[1] 

机构地区：[1]中南大学湘雅医院脊柱外科,湘雅脊柱,长沙410008

出　　处：《中华骨科杂志》2013年第1期32-38,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨脊柱侧凸三维矫形手术的并发症及其防治策略。方法2004年12月至2011年6月，应用三维矫形系统治疗各型脊柱侧凸727例：男245例，女482例；年龄3--62岁，平均18．2岁。冠状面Cobb角32°-142°，平均87．6°；矢状面Cobb角-10°-75°，平均45°。结果术后随访12-90个月，平均62．5个月。全组病例均安全完成矫形手术，冠状面矫正率55％~98％，平均85．2％；矢状面矫正率35％-67％，平均47．5％。本组病例术中、术后无一例死亡。术中、术后无脊髓损伤，102例患者共发生113例次并发症。内固定相关并发症26例：即椎弓根螺钉松动5例，断钉5例，断棒8例，脱钩3例，椎弓根切割5例，其中14例（椎弓根螺钉松动5例，断钉4例，断棒5例）发生于早期成人脊柱侧凸矫形术后。矫形并发症65例：交界性后凸36例，包括近端交界性后凸21例（其中11例为神经肌肉型侧凸），远端交界性后凸15例（其中4例马凡综合征伴脊柱侧凸，6例神经肌肉型侧凸）；adding—on现象22例；平背畸形7例。内科并发症（肺部并发症、肠系膜上动脉综合征）13例。手术相关并发症（伤口感染、压疮）9例。结论脊柱侧凸矫形术如术前准备充分、术中与术后处理得当，脊髓、神经损伤能获得有效预防。对于成人脊柱侧凸，顶椎区予以充足的内固定可有效减少断钉、断棒、椎弓根螺钉松动等内固定相关并发症；对于神经肌肉型侧凸、马凡综合征伴脊柱侧凸，适当延长融合节段可有效减少交界性后凸的发生。Objective To investigate the complications of three-dimensional correction surgery for scoliosis and the corresponding prevention and treatment strategies. Methods From December 2004 to June 2011, 727 cases of scoliosis were treated by three-dimensional correction system. There were 245 males and 482 females, aged from 3 to 62 years （average, 18.2 years）. Coronal Cobb angles ranged from 32° to 142° （average, 87.6°）, and sagittal Cobb angles ranged from -10° to 75° （average, 45°）. Results All patients were followed up for 12 to 90 months （average, 62.5 months）. All patients underwent surgery safely. The coronal correction rate ranged from 55% to 98% （average, 85.2%）, and the sagittal correction rate ranged from 35% to 67% （average, 47.5%）. There were no major complications such as death and nerve injury, but occurrences of other minor complications were 113 times in 102 cases. There were 26 cases of instrumentation-related complication, including 5 cases of pedicle screw loosening, 5 cases of broken screw, 8 cases of broken rod, 3 cases of hook loosening, and 5 cases of pedicle fracture; 14 cases of them occurred early after correction surgery for adult scoliosis. There were 65 cases of correction-related complication, including 36 cases of junctional kyphosis （21 cases of proximal junctional kyphosis, 11 cases of which were neuromuscular scolio- sis; 15 cases of distal junctional kyphosis, including 4 cases of Marfan syndrome with scoliosis and 6 cases of neuromuscular scoliosis）, 22 cases of adding-on phenomenon, and 7 cases of flat back. Internal medicine complications included 6 cases of superior mesenteric artery syndrome and 7 cases of pulmonary complica- tions. Operation-related complications included 4 cases of pressure sore and 5 cases of wound infection. Conclusion Accurate procedures of diagnosis and surgery for scoliosis are the key to decrease and prevent the complications. For adult scoliosis, enough instrumentation should be placed at the apical segments to de- crea

关 键 词：脊柱侧凸 手术后并发症 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]