先天性脊柱畸形手术治疗的总体疗效与并发症

Overall efficacy and complications of surgical treatment of congenital spinal deformity

目的:评估先天性脊柱畸形手术治疗的总体效果和并发症。方法:回顾性分析2007年4月~2018年1月本团队手术治疗的431例先天性脊柱侧凸患者,其中男158例,女273例,平均年龄14.9±6.2岁。术前均行全脊柱CT平扫和全脊柱MRI,排查椎管内畸形情况;心脏彩超和腹部B超检查排除其他内脏畸形。手术方式包括:生长撑开型非融合矫形技术(包括生长棒和人工钛肋)治疗40例,后路半椎体切除短节段固定融合术48例,后路长节段矫形固定融合术(可含1、2级截骨)89例,后路截骨(3级及以上截骨)矫形长节段固定融合术254例。每位患者均于术后3个月、6个月、1年和2年及以上时间进行随访。术前、术后及随访时均拍摄站立位全脊柱正侧位X线片,测量脊柱侧凸Cobb角、矢状面平衡(sagittal vertical axis,SVA)及冠状面平衡(C7PLCSVL)。统计手术时间、术中出血量和手术并发症情况。结果:431例患者合并椎管内畸形351例次、合并其他内脏畸形24例次。平均手术时间为412.4±150.6min,平均术中出血量为1879.9±1727.6ml,平均随访时间48.7±9.3个月。脊柱侧凸术前平均Cobb角为68.88°±27.55°,术后平均Cobb角为28.86°±18.90°,末次随访时30.77°±19.80°;SVA术前平均为22.15±19.37mm,术后24.15±22.22mm,末次随访时19.75±16.06mm;C7PL-CSVL术前平均为17.37±15.47mm,术后21.95±47.29mm,末次随访时13.03±12.39mm,末次随访的脊柱侧凸Cobb角和C7PL-CSVL与术前比较均有统计学差异(P<0.05)。术后肺部并发症49例、神经并发症30例、内固定相关并发症20例、术后感染10例以及脑脊液漏8例。结论:先天性脊柱侧凸手术矫形效果良好,但手术相关并发症风险较高,术后并发症总体发生率为30.16%,其中肺部并发症和神经并发症最为常见。

Objectives:To evaluate the overall efficacy and complications of surgical treatment of congenital spinal deformity.Methods:431 congenital scoliosis(CS)patients surgically treated by our team from April 2007 to January 2018 were retrospectively reviewed.All of them had complete 2-year follow-up,including158 male patients and 273 female patients with an average age of 14.9±6.2 years old.Before the surgeries,all the patients had computed tomography and magnetic resonance imaging of the whole spine to detect the deformity in the spinal canal,and echocardiography and abdominal ultrasound examination were also performed to exclude other visceral deformities.All the patients had surgical treatment,including growthfriendly non-fusion techniques(growing rods and vertical expandable prosthetic titanium rib)(n=40),posterior hemivertebra resection and short fusion(n=48),posterior spinal fusion without grade 3 or higher osteotomy(n=89),and posterior grade 3 or higher osteotomy and spinal fusion(n=254).All the patients had follow-up at 3 months,6 months,1 year and 2 years after surgery.Whole-spine radiographs were performed before surgery,after surgery and at each follow-up,and the Cobb angles,sagittal vertical axis(SVA),and the C7 plumb linecenter sacral vertical line(C7 PL-CSVL)were measured on the radiographs.The operation time,estimated blood loss and surgical complications were also collected.Results:351 cases of intraspinal malformations and 24 cases of other visceral malformations in 431 patients were identified.The average operation time was 412.35±150.57 mins,the average blood loss was 1879.93±1727.63 ml,and the average follow-up duration was 48.7±9.3 months.The average Cobb angle was 68.88°±27.55°at pre-operation,28.86°±18.90°at post-operation,and 30.77°±19.80°at final follow-up.The average SVA was 22.15±19.37 mm at pre-operation,24.15±22.22 mm at post-operation,and 19.75±16.06 mm at final follow-up.The average C7 PL-CSVL was 17.37±15.47 mm at preoperation,21.95±47.29 mm at post-operation,and 13.03±12.39 mm at final follow-up.Both the Cobb angle and C7 PL-CSVL at final follow-up had statistically significant differences compared with those before surgery,respectively(P<0.05).The complications included pulmonary complications(n=49),neurological complications(n=30),implant related complications(n=20),surgical infections(n=10)and cerebral-spinal fluid leakages(n=8).Conclusions:Surgical treatment of congenital scoliosis generally yields satisfying correction.However,the risk of surgical complications is relatively high,which is about 30.16%,especially for pulmonary and neurological complications.