摘要
背景:融合后脊柱侧凸翻修原因复杂,手术难度较高,围手术期及随访并发症发生率较高。目的:探讨融合后脊柱侧凸截骨翻修的原因、疗效、安全性及并发症。方法:回顾性分析2014年3月至2017年1月于我院行截骨翻修的50例融合后脊柱侧凸患者,男16例,女34例,年龄18~41岁,平均(27.5±6.4)岁。根据病因分成特发性脊柱侧凸(idiopathic scoliosis,IS)组(26例)和先天性脊柱侧凸(congenital scoliosis,CS)组(24例)。对比整体及各组手术效果,并统计分析围手术期和随访期间并发症。应用简体中文版SRS-22问卷进行患者生活质量评估。结果:本组病例随访24~65个月,平均(36.5±10.1)个月。IS组和CS组的截骨术式、手术时间、出血量、住院时间及随访时间均无显著性差异,IS组固定节段明显多于CS组(P<0.05)。50例患者的主弯侧凸角、节段性后凸角、顶椎偏移、T1倾斜角、矢状位平衡、腰椎前凸角及骨盆入射角与腰椎前凸角差值在术后即刻及末次随访时,与术前相比,均有显著性差异(P<0.05),而冠状位躯干偏移及锁骨角仅在末次随访时与术前相比有显著性差异(P<0.05)。IS组手术前后及末次随访时的主弯侧凸角与CS组相比均有显著性差异(P<0.05)。IS组术前及术后即刻的顶椎偏移与CS组相比有显著性差异(P<0.05)。本组20例(40%)患者出现并发症共23次,后路全脊椎切除术出现脊髓损伤次数明显增加。简体中文版SRS-22问卷5项指标在末次随访时均较术前有明显改善。结论:应用截骨术翻修融合后脊柱侧凸可以达到满意的临床效果,但整体并发症发生率较高,其中后路全脊椎切除术是脊髓损伤的高危因素。
Background:The causes of revision surgery in scoliosis patients with previous fusions are complex,and the operation is technically demanding,with a high incidence of complications during perioperative and follow-up.Objective:To investigate the causes,efficacy,safety and complications of revision osteotomy surgery in scoliosis patients with previous fusions.Methods:Fifty scoliosis patients with previous fusion who underwent revision surgery in our hospital from March 2014 to January 2017 were retrospectively analyzed.There were 16 males and 34 females with an mean age of(27.5±6.4)years old(range,18-41 years).According to the etiology,they were divided into idiopathic scoliosis(IS)group(n=26)and congenital scoliosis(CS)group(n=24).Surgical outcomes were assess in all the patients and compared between IS and CS groups.The incidence of complications was analyzed during perioperative period and follow-up.The simplified Chinese version of SRS-22 questionnaire was used to evaluate the quality of life of the patients.Results:The mean duration of follow-up was(36.5±10.1)months(ranged from 24 to 65 months).There was no significant difference in osteotomy method,operation time,estimated blood loss,hospital stay or follow-up duration between the two groups,but fusion length in IS group was significantly longer than that in CS group(P<0.05).The coronal main curve,segmental kyphosis,apical vertebral translation,T1 tilt angle,sagittal vertical axis,lumbar lordosis and mismatch between pelvic incidence and lumbar lordosis in 50 patients were significant improved immediately after operation and at the final follow-up(P<0.05).The coronal offset and clavicle angle only improved at the final follow-up(P<0.05).There was significant difference in the coronal main curve between the two groups preoperatively,postoperatively and at the final follow-up(P<0.05).So was the apical vertebral translation before surgery and immediately after surgery(P<0.05).Twenty-three complications occurred in 20(40%)patients.The frequency of spinal cord injury increased significantly in posterior vertebral column resection.All domains of the SRS-22 questionnaire were improved at the final follow-up.Conclusions:Revision osteotomy surgery can achieve satisfactory clinical outcomes in scoliosis patients with previous fusions,but it has a high incidence of complications.Posterior vertebral column resection is a risk factor for spinal cord injury.
作者
张乐乐
吴继功
马华松
李海侠
高博
王加旭
邵水霖
黄世博
ZHANG Lele;WU Jigong;MA Huasong;LI Haixia;GAO Bo;WANG Jiaxu;SHAO Shuilin;HUANG Shibo(Department of Orthopaedics,The 306th Hospital of PLA,Beijing 100101,China)
出处
《中华骨与关节外科杂志》
2020年第5期372-378,共7页
Chinese Journal of Bone and Joint Surgery
基金
首都临床特色应用研究(Z181100001718019)
关键词
脊柱侧凸
翻修术
截骨术
并发症
Scoliosis
Revision Surgery
Osteotomy
Complications
作者简介
通信作者:吴继功,E-mail:docwjg@163.com
