脊柱侧弯合并椎管内病变的一期手术治疗

One stage surgical treatment for scoliosis associated with intraspinal abnormalities

目的探讨一期手术治疗脊柱侧弯合并椎管内病变的有效性和安全性。方法与结果共6例脊柱侧弯合并椎管内病变患者均完成一期手术治疗,手术成功率为100%。手术时间(470.83±136.20)min,术中出血量1350(625,2150)ml,融合椎体节段(11.00±2.76)个;术后冠状位侧凸角度(19.60±5.94)°,矢状位后凸角度(25.80±10.87)°,均较术前改善(P=0.007,0.005);脊髓拴系行脊髓拴系松解术,表皮样囊肿、节细胞胶质瘤和椎管内脂肪瘤行椎管内病变切除术,脊髓空洞症不予特殊处理;无神经功能缺损恶化;术后下肢肌力增高,肌张力降低;排尿障碍改善。术后住院(8.83±3.31)d,无一例出现感染、脑脊液漏、脊柱内固定失败、椎弓根螺钉和钛棒断钉断棒等手术相关并发症,无一例死亡。术后随访(7.50±1.22)个月,均无神经功能缺损恶化、迟发性感染和假关节形成,均未出现矫形丢失。结论一期手术可以安全、有效地治疗脊柱侧弯合并椎管内病变,术后神经功能改善,通过截骨可以获得良好的矫形效果。

Objective To evaluate the effectiveness and safety of one stage surgical treatment for scoliosis and coexisting intraspinal abnormalities. Methods The data of 6 patients who underwent one stage surgical treatment for scoliosis and coexisting intraspinal abnormalities from October 2016 to January 2017 were retrospectively analyzed. Treatment for intraspinal abnormalities, posterior correction, osteotomy and internal fixation were performed simultaneously. The clinical and radiologic presentations, operative details, complications and postoperative outcomes were evaluated. Results The success rate was 100%. The operating time was （470.83 ± 136.20） min and intraoperative bleeding amount was 1350 （625, 2150） ml. Total fusion segments were 11.00 ± 2.76. Both Cobb angle of scoliosis [postoperation （19.60 ± 5.94）° vs. preoperation （59.40 ± 14.31）°, P = 0.007] and kyphosis [postoperation （25.80 ± 10.87）° vs. preoperation （62.40 ± 21.04）°, P = 0.005] were improved after operation. Tethered cords were released and epidermoid cyst, ganglioglioma and lipoma were excised. Syringomyelia was left untreated. No neurological functional defect or worsening was found. Muscle strength of all patients was improved. Muscular tone of 4 patients and difficulty in urination of 5 patients were also improved. The mean hospital stay was （8.83 ± 3.31） d. No severe complications, such as infection, cerebrospinal fluid （CSF） leakage, failed internal fixation, fractured pedicle screws or rods occurred after operation. None of the patients died, or experienced deterioration of neurological function, delayed infection, pseudoarthrosis, or loss correction during the （7.50 ± 1.22） months follow - up. Conclusions The one stage surgical treatment for scoliosis and intraspinal abnormalities seems to be a safe and effective approach. Neurological functional defect can be improved after operation. Osteotomy can improve correction result.