小儿脊柱侧弯术后急性脊髓功能障碍

Acute Cord Fuction Impairment in the Treat-ment of Scoliosis

１９８０年５月～１９９１年１２月收治脊拄侧弯５００例，术后并发急性脊髓功能障碍的８例。此８例中，特发性脊柱侧弯１例，先天性脊柱侧弯及后突７例。脊髓功能障碍表现为双下肢截瘫的３例，单肢瘫４例和Ｂｒｏｗｎ－Ｓｅｑｕａｒｄ综合症１例。２小时以内拆除矫正器械，８例中７例脊髓功能完全恢复，１例正在恢复中，作者强调术终缝合伤口前进行唤醒试验和及早拆除置入器械的重要性。作者认为术中随矫正而使脊髓移位、拉长、受压和血管被牵影响供血等均是脊髓功能障碍的原因。

Abstract)From May 1980 to December 1991,500 casesof scoliosis with various etiologies were admittedto our hospital. Average age:10.5 years( 3 to14).350 cases were congenital(70%),7 of whichdevelpped acute postoperative cord-function im-pairment,of the 130 cases of idiopathic scoliosis,only one case had a neurological complication,In311, paraplegia occurred in 3 cases,monoplegia inone case and Brown-Sequard syndrome in onecase.Paraplegia developed fllowing the oPerationsfor congenital kyphoscoliosis;in 3 of the 4 mono-plegia cases the,affected limb was that on the con-cave side of the scoliosis.Procedures used include Harrington,s instru-mentation(4 cases),Luque ’s procedure(1 case),U-shape rod( 2 cases)and spinal release(1case),all with the sublaminar wire technique.Inthe 8 cases in which caznplications of acute cord-functiOn impairment occurred,7 have recovered .of which 6 have received the second correction op-eration; one case was operated on recently and isstill on her way to recovery.The author considers that these complicationsare the result of traction,with translocation of,orchange in the tension on.the cord Or dura materand the affected blood vesse1s.This complication can be detected in timeduring the awakening test before closure of thewound Once the diagnosis is established, earlierremocal of the instruments plays the key role intreatment.