后路半椎体切除治疗先天性脊柱侧凸的并发症及预防策略

Complications and prophylaxis strategies of posterior hemivertebra resection for congenital scoliosis

目的 分析后路半椎体切除治疗半椎体所致先天性脊柱侧凸的并发症,并探讨预防策略.方法 回顾性分析接受手术治疗的半椎体所致先天性脊柱侧凸140例患者,其中男性70例,女性70例,平均年龄10.8岁,所有病例均采用后路半椎体切除、椎弓根螺钉固定及植骨融合术.术前、术后及随访时均拍摄站立位全脊柱正侧位X线片,对冠状面和矢状面Cobb角、冠状面畸形节段头侧及尾侧代偿弯Cobb角进行测量分析.同时统计各病例手术时间、融合节段、出血量及并发症情况.结果 手术时间平均229 min,术中出血量平均698.4 ml.随访时间3- 119个月,平均25个月.切除1-3个椎体,平均切除1.1个椎体.冠状面节段性侧凸Cobb角术前平均42.5°,术后10.6°,末次随访12.2°,矫正率为71.3％;节段性后凸Cobb角术前平均29.5°,术后6.6°,末次随访7.2°,矫正率为66.8％;畸形节段头侧以及尾侧代偿弯自行矫正率分别为52％和69.7％.共13例患者发生14例次并发症,发生率为9.29％,包括椎弓根骨折3例次,断棒2例次,椎弓根拉长2例次,因螺钉突出拆除内固定2例次,伤口并发症2例次,畸形加重行翻修2例次,呼吸延长1例次.无神经系统并发症.结论 后路半椎体切除术可以取得满意的畸形矫正效果,神经系统并发症发生率极低,但内固定相关并发症发生率较高,应予避免.

Objective To evaluate the surgical outcomes and related complications of posterior hemivertebra resection with transpedicular instrumentation in the treatment of congenital scoliosis caused by fully-segmented non-incarcerated hemivertebra.Methods From January 2003 to January 2012,one hundred and forty consecutive cases of congenital scoliosis treated by posterior hemivertebra resection with transpedicular instrumentation were investigated retrospectively.Radiographs were reviewed to determine the type and location of the hemivertebra,the coronal curve magnitude,sagittal alignment,compensatory cranial curve and compensatory caudal curve preoperatively,postoperatively and at the latest follow-up.Operative reports and patient charts were reviewed to record operation time,fusion level and complications.Results One hundred and fifty-one posterior hemivertebra resections in 140 patients aged 2 to 45 years （average 10.8 years） with non-incarcerated hemivertebra were evaluated.All the patients were followed up from 3 to 119 months （average 25 months）.The average fusion level was 5.0 segments （2-11 segments）.There was a mean improvement of 71.3％ in the segmental scoliosis from 42.5° before surgery to 10.6° at the time of the latest follow-up,and a mean improvement of 66.8％ in segmental kyphosis from 29.5° to 7.2° at the same periods.There were 14 complications （13 patients）,3 pedicle fractures,2 rod breakages,2 pedicle elongation,2 removed implants for prominent implants,2 delayed wound healing,2 additional surgeries for curve progression,1 prolonged respiratory support.There was no neurological complication.Conclusions Posterior hemivertebra resection with transpedicular instrumentation is a safe and effective procedure for congenital scoliosis patients.Neurological complication is rare,but implant-related complication still remains a challenge.