特发性脊柱侧凸手术并发症分析

目的：探讨特发性脊柱侧凸手术并发症及预防方法。方法：2002年6月至2007年5月治疗特发性脊柱侧凸86例,男21例,女65例;年龄8～22岁,平均17.8岁。侧凸按Lenke分型,1型33例,2型10例,3型18例,4型5例,5型10例,6型10例。Risser征0～Ⅰ度5例,Ⅱ～Ⅲ度20例,Ⅳ～Ⅴ度61例。术前患者冠状位主侧凸Cobb角45°～85°,平均Cobb角60.35°,采用TSRH等钉棒系统进行全脊柱椎弓根螺钉三维矫形、融合固定技术。对手术后矫形情况及手术后并发症进行总结。结果：所有患者平均手术时间3.2h,平均出血1000ml（800～2400ml）,共置椎弓根螺钉924枚,术后平均Cobb角18.46°。全部患者均获随访,时间5～40个月,平均20.5个月。86例患者中,1例脊髓损伤;25枚螺钉偏位;2例神经根损伤;1例胸膜损伤;1例肠系膜上动脉综合征;3例手术切口感染;2例躯体失平衡;1例交界性后凸;3例内固定松动;2例假关节形成;1例曲轴现象;2例平腰畸形。结论：特发性脊柱侧凸手术有很多种并发症,正确的诊治方案是减少并发症的关键。

Analysis of complications in scoliosis surgery

Objective：To analyze the complications occurred in scoliosis surgery and evaluate its prevention strategy. Methods：From June 2002 to May 2007,86 cases of idiopathic scoliosis were treated. There were 21 male and 65 female with an average age of 17.8 years（range,from 8 to 22 years）. According to Lenke classification,33 cases were type 1,10 type 2,18 type 3,5 type 4,10 type 5 and 10 type 6. Five cases were Risser 0 toⅠ,20 cases ⅡtoⅢ,61 cases ⅣtoⅤ. Cobb angles were from 45° to 85°（mean 60.35°）. The pedicle screw technique was used to correct all the scoliosis,and the results and complications were studied. Results：The average operation time was 3.2 hours and average blood loss volume was 1 000 ml（800～2 400 ml）,924 pedicle screws were inserted and the average postoperative Cobb angle was 18.46°. All the patients were followed up for 5 to 40 months（mean 20.5 months）. The complications were as following：1 case of spinal cord injury;25 screws misplaced; 2 cases of nerve root injury;1 case of pleura injury;1 case of superior mesenteric artery syndrome;3 cases of wound infection;2 cases of trunk decompensation;1 case of junction kyphosis;3 cases of implant loosening;2 cases of pseudarthrosis;1 case of crankshaft phenomenon;2 cases of flatback syndrome. Conclusion：Many kinds of complications may occur in scoliosis surgery. Exactitude procedures of diagnosis and surgery for the scoliosis are the key to decrease and prevent the complications related to the operation.