陈旧结核性脊柱后凸的后路全脊椎切除矫形手术效果和并发症  

The surgical outcome and complications of posterior correction with vertebral column resection for tuberculotic kyphosis

作　　者：钟沃权[1] 曾岩[1] 陈仲强[1] 齐强[1] 郭昭庆[1] 李危石[1] 孙垂国[1] 姜宇[1] 

机构地区：[1]北京大学第三医院骨科,100191

出　　处：《中华骨科杂志》2016年第14期921-928,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨后路全脊椎切除矫形手术治疗陈旧结核性脊柱后凸畸形的疗效及手术并发症的预防措施。方法自2004年6月至2012年10月采取后路全脊椎切除矫形固定手术治疗结核性脊柱后凸畸形患者56例，其中后凸顶椎位于胸段35例，胸腰段21例；53例患者存在相邻椎体的融合畸形；24例存在下肢神经功能损害；7例患者存在腰背部疼痛；15例患者同时存在下肢神经功能损害和腰背痛；10例无任何不适；56例患者均采用全脊椎切除＋双轴旋转矫形手术治疗。结果患者术前平均后凸角度为87．7°，术后平均为29．3°，矫正率为68．5％，术后平均随访25．3个月，平均后凸角度为30．9°，矫正率为66．6％，矫形丢失率为2．63％。以后凸顶点部分、畸形Cobb角度及发现畸形至手术的时间与有无并发症之间的Logistic回归分析，3个变量均未能构成出现并发症的危险因素。患者神经功能无加重，1例患者由FrankelA级恢复至D级，3例患者由FrankelC级恢复至D级，14例患者由FrankelD级恢复至E级，治疗效果较好。术中及术后并发症包括硬膜损伤4例，神经根损伤5例，术后一过性神经功能障碍4例，内固定松动1例，钛棒断裂3例，上述并发症分别经过术中修补硬膜、严密缝合切口，术后激素、脱水和神经营养药物治疗，二次手术翻修并重建稳定及融合等处理措施，均获得较好随访结果。并发症组（共17例）与无并发症组（共39例）患者的后凸矫正率及Oswestry功能障碍指数（Oswestrydysfunctionindex，ODI）评分改善率无统计学差异。结论结核性脊柱角状后凸畸形严重，全脊椎切除矫形手术治疗效果较好，手术治疗的并发症风险较高，需要围手术期严密监测和预防；通过积极正确处理，多数并发症恢复良好。Objective To investigate the outcome and prevention to complications of posterior correction with vertebral column resection for tuberculotic kyphosis. Methods From June 2004 to October 2012, posterior vertebral column resection and correction was performed in 56 patients with tuberculotic kyphosis. The kyphotic apex sited at thoracic segment in 35 cases and thoracolumbar segment in 21 cases. There were fusion deformities of contiguous vertebrae in 53 patients. There were 24 cases with neurological compromise, 7 cases with back pain, 15 cases with both, and 10 cases with no symptom. All the patients underwent vertebral column resection osteotomy with dual axial rotation corrective surgeries. Results The average preoperative kyphosis an- gle was 87.7°, which decreased to 29.3° after surgery, with an average correction rate of 68.5%. The average follow-up time was 25.3 months, when the average kyphosis angle was 30.9°, with an average correction rate of 66.6% and a loss rate of 2.63%. All the patients＂ neural functions did not deteriorate, which in detail were 1 case from Frankel A to D, 3 cases from C to D, 14 cases from D to E. The complications included dural tear in 4 cases, nerve root injury in 5 cases, transient neurologic deficit in 4 eases, prosthesis loosening in 1 case, titanium rod breaking in 3 case. All complications got good relief after relevant intervention includ- ing dural repair and sew up the incision tightly, methylprednisolone, dehydration or neurotrophic drug treatment, and revision sur- gery for rebuilding fixation and fusion. The prognosis was desirable. There were no statistical difference about the correction rate and Oswestry dysfunction index （ODI） improvement rate between the complication group （17 cases） and the no complication group （39 cases）. Conclusion The outcome of posterior correction with vertebral column resection for tuberculotic kyphosis was delight- ful while high surgical risk was noted. Intensive monitoring and preventing were recommended at perioperativ

关 键 词：结核 骨关节 脊柱后凸 椎体成形术 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]