脊柱侧凸矫正术中的神经损伤并发症

Intraoperative Neurological Complications in the Scoliosis

目的：分析脊柱侧凸矫正术中神经损伤的机理及防治措施。方法：５４例脊柱侧凸患者，男１８例，女３６例。Ｃ－Ｄ法矫正３３例，平均年龄１５．５岁，Ｃｏｂｂ角平均６６°；ＴＳＲＨ法矫正２１例，平均年龄１４岁，Ｃｏｂｂ角平均６８°。结果：Ｃ－Ｄ组矫正后Ｃｏｂｂ角减少至２６°，ＴＳＲＨ组减小至２８°。２例出现神经损伤（３．７％）。其中１例经唤醒试验发现神经损伤立即取出Ｃ－Ｄ棒，术后双下肢瘫痪。卧石膏床３个月，给予辅助性治疗，１年后基本恢复；另１例术中诱发电位显示波幅降低，但唤醒试验正常，术后右大腿有一过性感觉障碍，１周后恢复。结论：神经损伤应分为严重损伤和一过性损伤，前者应及时取出内固定器械，后者可严密观察。对畸形严重，尤其是双主弯者。

o investigate intraoperative neurological complications in scoliosis, 54 cases of scoliosis underwent C- D or TSRH instrumentation were reviewed. Of those, 2 patients developed intraoperative neurological complications. One patient was found having major spinal cord injury by wake up test during C- D instrumentation, and then all the implants were removed immediately. After physiotherapy and medication, the patients regained nearly normal function one year later. The other patient showed abnormal changes in cortical somatosensory evoked potentials(CSEP) monitoring during TSRH instrumentation. However, this patient only developed transient numbness in the right thigh and recovered in one week. The authors emphasized the importance of removal of internal fixation as soon as possible whenever the neurological injury was found. In case of correction of severe deformity, attention should be paid to the risk of neurological complications.