一期后路全脊椎切除治疗重度脊柱畸形围手术期并发症及其相关危险因素分析

Perioperative complications and risk factors of one-stage posterior vertebral column resection for severe spinal deformity

目的探讨一期后路个脊椎切除术治疗重度脊柱畸形形手术期许发症的发牛情况及其相关危险因素。方法2004年9川罕2012年7月接受一期后路全脊椎切除术治疗的雨度脊朴侧后凸患者39例，男15例，女24例；年龄3-53岁，平均16．9岁。侧后凸畸形24例，平均冠状面主弯Cobb角85．1°，平均后凸Cobb角92．9。；侧凸畸形7例，平均，冠状面主弯Cobb角81．1°；后凸畸形8例，甲均后凸Cobb角94．4°。术前合并神经功能障碍行11例。回顾性分析同手术期并发症的发生情况及其相火危险因素。结果围手术期共13例患者出现了15例次与于术相天的并发症。神经系统并发症6例次（15.4％）。青少年仲经系统并发症发生率明显低于成人．术前已经伴有及不伴有抻经损害表现患符的冲经并发症发生牢分别为36．4％和7．1％。出现神经系统并发症的患者术前均伴有后凸畸形，且后凸畸形严重者（后凸Cobb角≥90。）神经系统并发痛发乍率明显增高。术后呼吸支持时间延长4例次（10.3％）。壁层胸膜撕裂3例次（7．7％），脑脊液漏1例（2．6％），肺部感染1例次（2．6％）。结论一期后路食脊椎切除术足治疗晕度脊柱畸形的有效疗法，但围手术期并发症尤其是神经系统并发症发生率高。神经系统升发症的发牛与术前神经功能、患者年龄、后凸Cobb角大小相关。

Objective To investigate the perioperative complications and risk factors of one-stageposterior vertebral column resection （VCR） for severe spinal deformity. Methods From September 2004 to July 2012, 39 patients with severe and fixed spinal deformity underwent one-stage posterior VCR, including 15 males and 24 females, aged from 3 to 53 years （average, 16.9 years）. There were 24 eases of kyphoscoliosis （mean coronal Cobb angle： 85.1°, mean sagittal Cobb angle： 92.9°）, 7 cases of scoliosis （mean coronal Cobb angle： 81.1°）, and 8 cases of kyphosis （mean sagittal Cobb angle： 94.4°）. Eleven patients had neurological compromise. The perioperative complications and related risk factors of 39 patients were retrospectively analyzed. Results All patients were followed up for 3 to 72 months （average, 29.4 montbs）. There were 15 eases （13 patieuts） of perioperative complications. Neurological complications occurred in 6 patients （15.4%）, among whnm one patient presented complete paraplegia after surgery and 5 patients presented transient paresthesia or muscle weakness. Adults had a significantly higher incidence of neurological complications than teenagers. The incidence rate of neurological complications was 36.4% in patients with prenperative neurological compromise, while 7.1% in patients without preoperative neurological compromise. All patients with postoperative neurological complications had kyphosis before operation, and the incidence of neurological complications increased significantly in patients with severe kyphosis （Cobb angle ≥90°）. Prolonged respiratory support was conducted in 4 cases. Rupture of the parietal pleura oecurred in 3 cases （7.7%）, cerebrospinal fluid leak in I case （2.6%）, and pulmonary infection in 1 case （2.6%）. Conclusion One-stage posterior VCR is effective in the treatment nf severe and rigid spinal deformity. However, the perioperative complications, especially the neurological complications are common. The risk factors of neurological complications include preoperative neunrological compromise, degree of kyphosis and the age of patients.