经后路全脊椎切除术治疗重度僵硬性脊柱畸形的围手术期非神经并发症分析

Peri-operative major non-neurologic complications in posterior vertebral column resection

目的：分析经后路全脊椎切除术治疗重度僵硬性脊柱畸形患者围手术期主要非神经并发症的发生情况,探讨其相关危险因素。方法：回顾性分析2004年10月~2013年12月来自单中心的105例重度僵硬性脊柱畸形患者,均接受了一期经后路全脊椎切除术。对患者的一般资料,手术相关信息,围手术期及末次随访影像学资料,和围手术期非神经并发症进行统计并分析其相关因素。结果：患者手术时平均年龄18.9±8.1岁。主弯侧凸Cobb角术前为108.9°±25.5°,末次随访时为37.2°±16.8°;节段性后凸术前为89.8°±31.1°,末次随访时为30.4°±15.3°。手术平均切除1.31个椎节,固定涉及13.6±2.8个节段。至末次随访时,冠状面平衡矫正70.9%,矢状面平衡矫正53.4%。共24例患者（22.9%）发生了31例次非神经并发症事件：13例患者发生16例次呼吸系统并发症;7例患者发生9例次心血管不良事件;1例恶性高热;1例单眼失明;3例创口感染;1例神经纤维瘤病患者术后1d死亡。早期进行手术的患者（14/49）,以及切除T6或者以上节段椎体的患者（4/10）,显示了较多的非神经并发症的趋势。此外,非特发性畸形,超过150°的极度重度脊柱侧凸,术前用力肺活量和第一秒用力呼气量低于预计值40%,以及术中失血量超过5000ml是非神经并发症的危险因素。结论：经后路全脊椎切除矫形的患者,围手术期中非神经并发症的发生率较高,并与患者肺功能状况不佳及术中失血量大有关。

Objectives： To analyze the peri-operative major non-neurologic complications（MNNCs） in posterior vertebral column resection（PVCR） procedures, and to identify the factors that may increase the risk. Methods： A total of 105 consecutive patients with severe rigid deformity who underwent one-stage PVCR at a single center from 2004 to 2013 were reviewed. The demographic data, medical and surgical histories, perioperative and final follow-up radiographic measurements, prevalence of perioperative MNNCs were reviewed. Results： The mean age of patients at the time of surgery was 18.9±8.1（10-45） years. The major curve of scoliosis was 108.9°±25.5° preoperatively and 37.2°±16.8° at the final follow-up, and segmental kyphosis was from 89.8°±31.1° to 30.4°±15.3°. Vertebral resection involved an average of 1.31 levels, and fusion extended an average of 13.6±2.8 levels. The coronal balance correction rate was 70.9%, and sagittal balance correction rate was 53.4%. There were 31 MNNCs in 24 patients： 16 respiratory complications in 13 patients, 9 cardiovascular adverse events in 7 cases, l malignant hyperthermia, and 1 optic deficit. There were 3 cases with wound infection, and 1 of them had to be partly removed the implant for infection control. One patient with neurofibromatosis died at one day after operation. Patients with T6 and upper resected level, undergoing PVCR at the early period, showed a trend toward more MNNCs encountered. Moreover, non-idiopathic deformity, large scoliotic curve 〉150°, percent predicated FVC and FEV1.0 〈40%, and EBL〉5000ml were identified as risk factors associated with MNNC. Conclusions： Patients who undergo posterior vertebral column resection（PVCR） experience expect highly rate of major non-neurologic complications, and it is associated with poor puhnonary function and the amount of blood loss during operation.