退行性脊柱侧凸三维矫形术并发症的探讨

目的:探讨使用椎弓根螺钉系统矫治退行性脊柱侧凸的并发症及其预防措施。方法:对82例退行性脊柱侧凸患者采用4种不同的手术方式:17例先行一期前路松解、支撑性融合,二期后路多节段椎弓根螺钉矫形,后外侧植骨融合;41例行后路椎管减压、椎体间支撑融合(PLIF)、椎弓根螺钉矫形内固定 后外侧植骨融合术;14例行后路短缩、椎管减压、椎弓根螺钉矫形内固定 后外侧植骨融合术;10例行椎管减压、椎弓根矫形内固定 后外侧植骨融合术。对75例获得6个月至4年(平均2年3个月)随访患者的并发症进行回顾性分析。结果:本组无围手术期死亡,术后重症监护时间平均22h,切口感染1例,切口延迟愈合4例;7例术后出现肺部感染,经处理后好转;6例手术后出现心脏病复发,经内科联合处理后好转;9例术后出现双下肢疼痛,经保守治疗3个月症状缓解;4例腰背部疼痛缓解不明显。无断钉、断棒现象。88.6%的患者对手术治疗的结果满意。结论:三维矫形手术治疗退行性脊柱侧凸的并发症较多且严重,手术治疗需慎重考虑患者的全身情况及术前症状,以选择适合的手术方式。

A study on the complication of posterior pedicle screws correction technique for degenerative scoliosis

Objective:To investigate the complication and prevention methods of posterior pedicle screws correction technique for degenerative scoliosis.Method:82 patients including 17 cases with first anterior spinal release,structural grafting,2nd stage posterior correction with pedicle screw system and posterolateral bone grafting.41 cases with one-stage posterior pedicle screws instrumentation correction,and PLIF intervetebra combined with posterolateral fusion.14 cases with posterior shortening and pedicle screw system correction with posterolateral bone grafting.10 cases only posterior decompression and pedicle screws fixation with posterolateral bone grafting.In this group.75 cases have been finished 6 months~4 years(average 2 years and 3 months) follow-up,and a retrospective study on their complication.Result:No death was noted,and average ICU time was 22h.1 cases wound infection.4 cases delayed incision healing.Medical complication including 7 cases pneumonia,recovered by treatment.6 cases recured cardiopathy,recovered by internal medicine.9 cases occured both lower extremities pain,and relieved after 3 months conservative treatment.4 cases still suffered from low back pain.No instrumentation broken.88.6% patients were satisfied with surgical result.Conclusion:There are many severe complications in posterior 3 dimensional technique of pedicle screws instruments treated for degenerative scoliosis.You should consider patients health condition and symptoms before operation,then select properly operation strategy.