后路全脊椎截骨治疗重度脊柱角状后凸畸形的围手术期并发症分析

目的：分析经后路全脊椎截骨（posteriorvertebralcolumnresection，PVCR）治疗重度脊柱角状后凸畸形的围手术期并发症。方法2006年1月至2013年12月，我科采取后路顶椎区全脊椎截骨治疗重度脊柱角状后凸畸形患者38例，男21例，女17例，年龄13～61岁，平均27.5岁。术前后凸Cobb’s角平均116°（85～175）°，侧凸Cobb’s角平均16°（0～40）°。对临床结果进行评估，并对围手术期并发症进行分析。结果手术时间平均312（210～470）min，术中出血量平均2089（800～4500）ml，随访时间平均43.5（6～72）个月，术后脊柱后凸Cobb’s角平均43.6°（10～98）°，矫正率为62.4%；术后侧凸Cobb’s角平均5.2°（0～12）°，矫正率为67.5%。16例（42.1%）发生围手术期并发症。其中发生神经系统并发症5例（13.2%），包括完全性脊髓损伤1例，一过性神经功能障碍4例；非神经系统并发症早期9例（23.7%），包括胸腔积液2例，硬膜损伤2例，螺钉拔出3例，伤口表浅感染1例，胃肠道功能障碍1例；中期并发症2例（5.3%），包括内固定棒断裂1例，后凸加重1例。结论 PVCR是治疗重度脊柱角状后凸畸形的有效手术方法，但其潜在的严重并发症不可忽视。

Perioperative complications of posterior vertebral column resection for patients with severe angular kyphosis

Objective To analyze the perioperative complications of posterior vertebral column resection （ PVCR ） for the patients with severe angular kyphosis. Methods From January 2006 to December 2013, 38 patients with severe angular kyphosis were treated by PVCR. There were 21 males and 17 females, whose average age was 27.5 years old （ range：13-61 years ）. The preoperative kyphosis angle and scoliosis angle were 116° （ range：85°-175° ） and 16° （ range： 0°-40° ） respectively. The clinical outcomes were evaluated and the perioperative complications were analyzed. Results The average operation time was 312 min （ range：210-470 min ）, and the average blood loss was 2089 ml （ range：800-4500 ml ）. The average follow-up time was 43.5 months （ range：6-72 months ）. The mean postoperative kyphosis angle was 43.6° （ range：10°-98° ） and the correction rate was 62.4%. The mean postoperative scoliosis angle was 5.2° （ range：0°-12° ） and the correction rate was 67.5%. The total perioperative complication rate was 42.1%（ 16/38 ）. Neurological complications occurred in 5 patients （ 13.2%）, including complete spinal cord injury （ n=1 ） and transient neurological deifcit （ n=4 ）. There were 9 cases of early non-neurological complications （ 23.7%）, including hemothorax （ n=2 ）, dural injury （ n=2 ）, loosening of pedicle screw （ n=3 ）, superiifcial wound infection （ n=1 ） and gastrointestinal dysfunction （ n=1 ）. The medium-term complications were noticed in 2 cases （ 5.3%）, including rod breakage （ n=1 ） and kyphosis aggravation （ n=1 ）. Conclusions PVCR is an effective method for severe angular kyphosis, and its potential risk of severe complications should be paid more attention.