经椎弓根椎体截骨术治疗强直性脊柱炎胸腰椎后凸畸形术中出血情况的分析

The bleeding pattern in ankylosing spondylitis patients with thoracolumbar kyphosis treated with pedicle subtraction osteotomy

目的:探讨经椎弓根椎体截骨术(pedicle subtraction osteotomy,PSO)治疗强直性脊柱炎(ankylosingspondylitis,AS)胸腰椎后凸畸形患者术中各操作阶段的出血情况。方法:选取2012年4月～2012年11月行单节段PSO治疗,并有完整术前、术后临床资料的AS胸腰椎后凸畸形患者21例,其中男性19例,女性2例;平均年龄35.7±12.7岁(18～65岁)。所有患者均记录术前最大后凸角(global kyphosis,GK),固定节段数及截骨部位;术中操作分为暴露、置钉、PSO截骨、复位、安装矫形棒及植骨闭合切口6个阶段,分别记录各阶段的时间及出血量。结果:术中无神经并发症发生。手术过程总出血量1869.2±378.5ml,暴露阶段出血116.6±52.5ml,置钉阶段出血236.4±91.1ml,PSO截骨阶段出血832.1±223.5ml,复位出血210.9±61.8ml,安装矫形棒阶段出血244.7±42.0ml,植骨闭合切口阶段出血228.5±46.1ml。其中暴露、置钉、PSO截骨、复位、安装矫形棒及植骨闭合切口6个阶段出血量分别占总出血量的6.2%、12.6%、44.5%、11.2%、13.0%及12.5%。结论:PSO治疗AS胸腰椎后凸畸形术中出血主要在截骨阶段,此阶段应保证足够的血液灌注,以减少因脊髓低灌注而产生的神经并发症。

Objectives： To investigate the bleeding pattern in the process of pedicle subtraction osteotomy （PSO） for treating thoracolnmbar kyphosis with concomitant ankylosing spondylitis（AS）. Methods： Twenty-one AS patients performed with one level PSO were included in this study. There were 19 males and 2 females, with the mean age of 35.7±12.7 years （range, 18 to 65 years）.The recorded parameters included global kypho- sis （GK）, the number of fixation segments and PSO level. The surgical procedures were divided into the fol- lowing six phases：exposure, pedicle screws placement, PSO, closure of the osteotomy site, correction rod placement and closure of the incision. The operation time and the blood loss at each stage were recorded. Results： The total blood loss was 1869.2±378.5ml. The blood loss in the phases of exposure, pedicle screws placement, PSO, closure of the osteotomy site, correction rod placetnent and closure of the incision were 116.6±52.5ml, 236.4±91.1ml, 832.1±223.5ml, 210.9±61.8ml, 244.7±42.0ml and 228.5±46.1ml, respectively. The percentage of blood loss at each stage was 6.2%, 12.6%, 44.5%, 11.2%, 13.0% and 12.5%, respectively. Conclusions： The largest portion of blood loss occurred in the PSO. Therefore, sufficient blood perfusion must be provided to reduce the risk of spinal cord ischemia at this phase.