脊柱畸形两种后路截骨矫形术的并发症分析

Analysis on Complications of Two Posterior Osteotomy for Spinal Deformity

目的分析脊柱后路截骨矫形术术后并发症原因。方法回顾性分析湘雅医院脊柱外科自2004年至2011年行后路截骨矫形手术的患者共233例,平均年龄33.5岁,分析患者行后路经椎弓根完整切除椎体矫形术及蛋壳去松质截骨术术后并发症原因。结果术后患者局部后凸畸形从51.4°矫正到2.7°,胸椎侧凸畸形从63.9°矫正到24.5°(矫形率62.6%),腰椎侧凸畸形从50.1°矫正到17.1°(矫形率67.6%)。术后总的并发症发生率为40.3%,后路经椎弓根完整切除椎体矫形术和蛋壳去松质截骨术在术后并发症发生率方面没有明显差异。和年轻患者相比,年龄超过35岁患者术后并发症更多(P<0.05)。术中失血量超过3,000 ml,手术时间超过200分钟,术后更容易出现并发症(P<0.05),术中大于5个节段的融合会增加并发症并且术后易发生神经功能障碍(P<0.05)。许多患者术前就存在神经功能障碍,术前结核性后凸畸形术的患者术后并发症发生率更高且容易发生神经功能障碍(P<0.05)。矫正大于40°的后凸畸形可能会增加并发症和术后神经功能障碍,但无统计学差异(P>0.05)。术中1例因心衰死亡,15例因内固定问题和进行性矫正丢失行翻修手术。结论后路椎体切除截骨矫形手术术后总并发症为40.3%。年龄、术中失血量、术前后凸畸形严重程度和融合节段的长短是导致术后并发症的原因。

Objective To analyze the reasons of postoperative complications after posterior osteotomy for spinal deformity.Methods A total of 233 patients given posterior osteotomy surgery in Spine surgery of Xiangya hospital from 2004 to 2011 were retrospectively analyzed.Mean age of all patients was 33.5 years.The reasons of postoperative complications for patients who were proceeded posterior pedicle screw complete resection of vertebral orthopedic surgery and the shell to cancellous osteotomy were analyzed.Results The postoperative local kyphosis was corrected from 51.4 ° to 2.7 °,thoracic scoliosis was corrected from 63.9 ° to 24.5 °（correction rate was 62.6%）,lumbar scoliosis was corrected from 50.1 ° to 17.1 °（correction rate was 67.6%）.Overall complication rate after operation was 40.3%.The incidence of postoperative complications after posterior pedicle complete removal of the vertebral orthopedic surgery and the shell to cancellous osteotomy were no significant different.Postoperative complications in younger patients was more than those in older patients who was over 35 years（P〈0.05）.If intraoperative blood loss was more than 3,000 ml or operation time was over 200 minutes,postoperative complications would be more easily happened（P〈0.05）.If there were greater than 5 segments fusion during surgery would increase complications and was prone to having neurological dysfunction（P〈0.05）.Many patients with preoperative neurologic dysfunction and preoperative tuberculous kyphosis had a higher incidence of neurological dysfunction（P〈0.05）.The kyphosis correction greater than40° might increase complications and postoperative neurological dysfunction,but there were no significant difference（P〈0.05）.Furthermore,there was one patient died due to heart failure and 15 cases without revision surgery due to internal fixation and progressive loss of correction line.Conclusion Postoperative complication rate in posterior vertebral body resection and osteotomy surgery was40.3%.Ages,intraoperative blood loss,convex deformity severity after surgery and length of fusion segments can lead to postoperative complications.