脊柱侧凸的再手术治疗

Revision of scoliosis surgery

目的探讨及评价脊柱侧凸再次手术的原因、方法和疗效。方法1996～2002年,36例脊柱侧凸手术后患者接受再手术治疗。其畸形程度为侧凸52°～108°,平均76.2°;其中合并11例后凸36°～79°,平均53°。手术方法包括:内固定拆除、原融合松解或截骨、椎弓根螺钉固定矫形融合。结果手术均安全完成,手术时间平均3.8h(2.8～5.1h),出血量平均817ml(630～1800ml),侧凸矫正平均48°(56%);后凸矫正平均47°(72%)。无神经系统并发症发生。结论脊柱侧凸翻修手术具有难度和危险大的特点,对每1例患者进行详细的术前检查和评价,针对每1例患者的畸形特点周密设计手术方案,是获得满意矫正效果的关键。

Objective To evaluate and determine the reasons, methods and results of revision surgery for patients with previous scoliosis surgery failure. Methods 36 patients with previous failed scoliosis surgery underwent revision surgery between 1996 and 2002. The preoperative deformity of scoliosis was 76.2 degrees (58~108) in which 11 patients were complicated by kyphosis with average Cobb angle of 53 degrees (36~79). The surgical procedures included removal of previous instruments, osteotomy at previous fusion mass, trans-pedicular fixation and fusion. Results All the patients underwent surgery safely. The average operating time was 3.8 hours (2.8~5.1) and average blood loss was 817 ml (630~1800 ml). The correction of the deformity was 48 degrees (56%) for scoliosis and 47 degrees (72%) for kyphosis. There was no neurological complication occurred in all patients. Conclusions Revision for scoliosis surgery is characterized with higher difficulty and risk. Careful examination and evaluation for each patient before operation and proper selection of surgical procedures according to each patient’s deformity are the keys for achieving satisfactory results.