一期后路全脊椎截骨术治疗严重脊柱畸形术后30天非计划再手术原因分析及处理策略  

Causal analysis and management strategies of 30-day unplanned revision surgery following single-stage posterior vertebral column resection for severe spinal deformity

作　　者：陶有平[1] 吴继功[1] 马华松[1] 邵水霖[1] 张乐乐[1] 高博[1] 李海侠[1] Tao Youping Wu Jigong Ma Huasong Shao Shuilin Zhang Lele Gao Bo Li Haixia(Department of Orthopaedics, Spinal Center of People＇s, Liberation Army, the 306th Hospital of People＇s Liberation Army, Beijing 100101, China)

机构地区：[1]解放军第三○六医院骨科全军脊柱外科中心,北京100101

出　　处：《中华外科杂志》2017年第3期179-185,共7页Chinese Journal of Surgery

摘　　要：目的 探讨一期后路全脊椎截骨术（PVCR）治疗严重脊柱畸形术后30 d非计划再手术的原因及处理措施.方法 回顾性分析2010年5月至2015年12月于解放军第三○六医院骨科行一期PVCR手术治疗的112例严重脊柱畸形患者资料,其中6例术后30 d发生非计划再手术,男性2例,女性4例;年龄12～38岁,平均21岁.包括先天性脊柱侧后凸4例,椎板切除术后脊柱侧后凸1例,陈旧结核性脊柱角状后凸1例.术前3例患者合并下肢神经损伤表现,脊髓功能Frankel分级：C级1例,D级2例.记录PVCR术后30 d非计划再手术的原因、处理措施及临床转归.结果 本组PVCR术后30 d非计划再手术发生率为5.4％.原因：脑脊液漏1例,神经损伤并发症5例,包括硬脊膜褶皱压迫1例、截骨端残留骨块1例、硬膜外血肿2例、急性硬膜下血肿1例.6例患者均进行再次手术,包括硬膜修补、椎板扩大减压、清除骨块及血肿清除等对症处理,均完全恢复.随访时间10～60个月,平均30.8个月.本组6例患者冠状面侧凸Cobb角由术前平均87.7°矫正至34.2°,矫正率为61.0％;矢状面后凸Cobb角由术前平均119.5°矫正至45.5°,矫正率为61.9％.脊髓功能Frankel分级：1例术前C级、2例D级均恢复至E级.结论 一期PVCR手术是治疗严重脊柱畸形的有效方法.术后30 d非计划再手术原因包括脑脊液漏、截骨区硬脊膜褶皱、残留骨块、血肿等;及时再次手术可获得良好的临床疗效.Objective To investigate the causes of 30-day unplanned revision surgery following one-stage posterior vertebral column resection （PVCR） for severe spinal deformity and the methods of prevention and management.Methods A total of 112 severe deformity patients underwent one-stage PVCR for surgical treatment in the 306th Hospital of People＆#39; s Liberation Army from May 2010 to December 2015 were retrospectively reviewed.Six patients required reoperation within 30 days after PVCR,including 2 males and 4 females with average age of 21 years （ranging from 12 to 38 years）.Four cases were congenital kyphoscoliosis,1 was post-laminectomy kyphoscoliosis and 1 was post-tuberculous angular kyphosis.Three cases associated with preoperative neurologic deficit （Frankel C in 1 patient and D in 2 patients）.The causes,management and outcomes of unplanned revision surgery within 30 days after PVCR were recorded.Results The total incidence of unplanned revision surgery within 30 days following PVCR was 5.4% （6/112）.There was 1 case due to cerebrospinal fluid leak,5 cases with varying degrees of new neurologic deficits,the causes were as followed：dural buckling in 1 case,residual bone compression in 1 case,epidural hematoma compression in 2 cases,spinal subdural hematoma in 1 case.All the 6 cases underwent surgical exploration again,including further dural repair,decompression and hematoma clearance.After unplanned reoperation,6 cases recovered completely.The average follow-up time after surgery was 30.8 months （ranging from 10 to 60 months）.The major curve at coronal plane was improved from preoperative 87.7° to 34.2°,with a mean correction of 61.0% at final follow-up;the sagittal kyphosis curve was improved from preoperative 119.5° to 45.5°,with a mean correction of 61.9% at final follow-up.Two patients＆#39; neurological status improved from Frankel D to Frankel E,one patient＆#39;s neurological status improved from Frankel C to Frankel E.Conclusions One-stage PVCR could be an effective method for t

关 键 词：脊柱畸形 截骨术 非计划再手术 

分 类 号：R687.3[医药卫生—骨科学]