一期后路全脊椎切除术治疗重度僵硬性胸腰椎畸形的并发症分析

Complications of one stage posterior vertebral column resection for the treatment of severe rigid spinal deformities

目的 分析一期后路全脊椎切除、椎弓根螺钉固定矫治重度胸腰椎畸形的并发症.方法 2000年2月至2009年2月通过一期后路全脊椎切除治疗重度胸腰椎畸形患者54例,男性23例,女性31例;年龄16～58岁,平均28.3岁.侧凸畸形9例,冠状面主弯Cobb角平均91.7°;侧后凸畸形22例,冠状面主弯Cobb角平均101.5°,后凸角平均69.4°;角状后凸畸形21例,后凸角平均72.2°;圆弧状后凸2例,后凸角平均93.6°.采用主弯区顶椎全脊椎切除、全节段椎弓根螺钉内固定和360°植骨融合术.对临床结果进行评估,统计并分析并发症发生情况.结果 平均切除椎体1.4个,手术时间平均470 min,术中出血量平均4180 ml.随访时间12～66个月,平均26个月.末次随访侧凸畸形平均矫正61.4°（67%）;侧后凸畸形中侧凸平均矫正59.7°（56%）,后凸平均矫正42.3°（59%）;角状后凸平均矫正48.5°（71%）;圆弧状后凸平均矫正62.7°（67%）.共有17例患者出现21例次并发症（38.9%）,其中早期神经系统并发症5例次（9.3%）,包括1例完全性脊髓损伤.非神经系统并发症早期11例次（20.4%）,后期5例次（9.3%）.结论 一期后路全脊椎切除治疗胸腰椎脊柱畸形可以取得较为满意的畸形矫正结果,但其潜在的严重并发症不可忽视.

Objective To summarize the complications of posterior vertebral column resection （pVCR） and pedicle screw fixation for the treatment of rigid thoracic and lumber spinal deformity. Methods Fifty four patients from a single center from February 2000 to February 2009 were included in this study.There were 23 males and 31 females with an average age of 28. 3 years （range, 16-58 years）. Patients were divided into 4 diagnostic categories： severe scoliosis （ n = 9, mean Cobb angle, 91.7°） , kyphoscoliosis （n =22, mean scoliosis, 101.5° , and mean kyphosis, 69. 4°） , angular kyphosis （n =21, mean kyphosis,72. 2°）, global kyphosis （n = 2, mean kyphosis, 93.6°）. All of the patients received one stage pVCR combined correction with pedicle screws and circumferential fusion. Radiographs and hospital charts were reviewed to analyze the outcomes of correction. Results A mean of 1.4 vertebral levels were resected, the mean operative time was 470 min, and the mean blood loss was 4180 ml. All the patients were followed-up for an average time of 26 months （range, 12-66 months）. At the latest follow-up, the major curve correction averaged： severe scoliosis 61.4° （67%）, kyphoscoliosis 59. 7° （56%） /kyphosis 42. 3° （59%）, angular kyphosis 48.5° （71%）, global kyphosis 62.7° （67%）. A total of 21 complications （38.9%） occurred in 17 patients, including 5 （9. 3% ） neurological complications happened in early stage and one case of delayed complete paraplegic. There were 11 （20. 4% ） non-neurological complications happened in early stage and 5 （9. 3% ） cases in late stage. Conclusions One stage posterior-only vertebral column resection can achieve satisfactory correction of severe deformities with limited flexibility. Given its technically demanding and exhausting features, its potential risk of significant complications should be paid more attention.