两种截骨矫形术治疗强直性脊柱炎胸腰椎后凸畸形的围手术期并发症比较

Perioperative complications of osteotomy correction for thoracolumbar kyphosis in ankylosing spondylitis:a comparison between polysegmental wedge osteotomies and transpedicular wedge osteotomy

目的:比较两种截骨矫形术式治疗强直性脊柱炎胸腰椎后凸畸形的围手术期并发症,分析原因并提出预防措施。方法:1997年7月～2007年12月,在我院行强直性脊柱炎胸腰椎后凸畸形截骨矫形治疗且有完整资料记录的患者共93例。根据截骨术式的不同分为两组:多节段经关节突"V"形截骨组(PWO组)共32例,男29例,女3例,年龄22～60岁,胸腰段后凸Cobb角24°～78°,平均53.4°;单节段经椎弓根椎体截骨组(TWO组)共61例,男53例,女8例,年龄20～56岁,胸腰段后凸Cobb角30°～82°,平均56.2°。统计两组患者的围手术期并发症。结果:所有患者术中、术后无死亡、无感染。PWO组术中气管套管脱落1例(3.1%),术中螺钉松动2例(6.2%),硬脊膜破裂4例(12.5%),神经根损伤1例(3.1%),术后胃肠道并发症5例(15.6%)。TWO组术中螺钉松动3例(4.8%),术中截骨端脱位2例(3.2%),硬脊膜破裂1例(1.6%),术中大出血5例(8.1%),神经并发症5例(8.2%),术后麻痹性肠梗阻3例(4.8%),后凸过度纠正1例(1.6%)。结论:由于截骨方法的差异,PWO与TWO手术具有不同的围手术期并发症发生构成。应采取针对性的预防处理措施,以减少并发症的发生。

Objective：To analyze perioperative complications between polysegmental wedge osteotomies and transpedicular wedge osteotomy for thoracolumbar kyphosis in ankylosing spondylitis.Method：93 patients were divided into two groups.Group 1 of 32 cases underwent polysegmental wedge osteotomy （PWO）,including 29 males and 3 females with an age range of 22 to 60 years.Group 2 was corrected by mono-level transpedicular wedge osteotomy （TWO）.There were 61 cases （53 males,8 females） with an age range from 20 to 56 years.Perioperative complications were compared between two groups.Result：No death and infection occurred.In group 1 ,perioperative complications included tracheal tube pull-out during operation in 1 cases （3.1%）,dural tear in 4 （12.5%）,intraoperative pedicle screw looseness in 2 （6.2%）,gastrointestinal complications in 5 （15.6%） ,and nerve root injury in 1 （3.1%）.In group 2,pedicle screw looseness during operation occurred in 3 cases （4.8%）,intraoperative dislocation in 2（3.2%）,dural tear in l（1.6%）,paraiytic ileus in 3（4.8%）,massive bleeding in 5 （8.1% ）, neurologie deficit in 5 （8.2%）, and kyphosis overeorrection in 1 （ 1.6% ）.Conclusion： Two kinds of osteotomy techniques have different pattern of perioperative complications.Appropriate measures for each technique may play an efficient role in reducing perioperative complications.