退行性脊柱侧凸患者手术疗效及相关并发症分析

Analysis of surgical effects and related complications for patients with degenerative scoliosis

目的探讨成人退行性脊柱侧凸（DDS）手术的临床效果，分析与手术相关的围术期及远期并发症。方法对2000年8月至2011年8月北京协和医院收治的320例DDS手术患者的临床资料进行回顾性分析。采用Oswestry功能障碍指数（ODD评分及改良Prolo评分评估手术效果，记录患者手术满意度，观察手术相关并发症发生情况。结果随访时间1～8年，平均随访时间4．2年。末次随访患者平均ODI评分为38．2分（25~48分），手术优良率80．9％，手术满意度80．9％。17例（5．3％）患者出现手术相关并发症：围术期并发症包括内固定位置不佳6例（其中3例伴下肢神经症状）、脑卒中l例、脑脊液漏1例、伤口愈合不良3例；远期并发症包括内固定松动2例、邻近节段退行性变4例。结论由于成人DDS患者多为高龄，椎体存在节段性旋转畸形，因此手术相关并发症发生率较高。术前认真查体、仔细分析影像学资料、充分结合患者临床症状，有助于选择合理的手术方案，取得满意的临床效果，同时预防手术相关并发症的发生。

Objective To explore clinical effects and analyze the perioperative and long-term complications associated with surgical treatment for adult de-novo degenerative scoliosis （DDS）. Methods Clinical data of 320 DDS patients underwent operations in Peking Union Medical College Hospital from August 2000 to August 2011 were retrospectively reviewed. Clinical efficacy was evaluated by Oswestry disability index （ODI） and modified Prolo scoring, degree of satisfaction of patients was recorded, and the complications related to the operations were observed. Results All patients were followed up from 1 to 8 years （average, 4.2 years）. At the final follow-up, average ODI score was 38.2 （25-48）, the excellent and good rate of modified Prolo scoring was 80.9%, degree of satisfaction of patients was 80.9%. Complications associated with surgical treatment occurred in 17 patients （5.3%）, including perioperative complications （poor location of pedicle screws in 6 cases, stroke in 1 case, cerebrospinal fluid leakage in 1 case and poor wound healing in 3 cases） and long-term complications （internal fixation loosening in 2 cases and adjacent segment degeneration in 4 cases）. Conclusions The prevalence of complications associated with surgical treatment for adult DDS is relatively high because most of DDS patients were elderly, and there existed segmental rotatory deformity in vertebral bodies. So it is quite important for the surgeons to comprehensively analyze the neurological signs, imaging data and clinical symptoms before the surgry, so as to choose appropriate surgical program to prevent surgery-related complications and get satisfied effects.