严重脊柱侧凸患者围手术期并发症及其预防

目的：对严重脊柱侧凸患者围手术期并发症进行总结分析，并探讨其预防措施。方法：自1997年7月～2002年12月，矫治90。以上严重脊柱侧凸患者184例。手术分为4类：(1)先行Halo牵引、呼吸功能锻练1～3个月后，再行单纯后路矫形(4例)或前路松解2周后二期后路矫形(38例)；(2)前路松解，牵引2周后行后路矫形(112例)；(3)自体胫骨行前路支撑融合，2周后施行后路矫形(18例)；(4)一期前路骨骺阻滞加后路矫形(12例)。结果：牵引中并发短暂性神经损害9例；后路矫形术中心跳骤停1例(复苏成功)，术后下肢不全性瘫痪1例，肺部并发症10例。结论：严重脊柱侧凸患者的畸形僵硬、躯干倾斜明显，常伴有心肺功能减退或脊髓神经损害．其围手术期并发症的发生率较高。采取积极有效的措施可降低围手术期并发症的发生率。

Analysis and preventive measures of perioperative complications for severe scoliosis

Objective:To analyse perioperative complications of severe scoliosis,and investigate the measures for its prevention.Method:From July1997to Dec.2002,184cases with severe scoliosis were treated.All pa-tients were divided into four groups for surgical treatment:(1)42cases underwent the Halo-femur traction and ventilation training for1to3months,then the posterior correcton of scoliosis were performed on4cases,and the two-stage antero-posterior correcton on38cases.(2)112cases had two-stage surgery,the first being ante-rior spinal release,after a14-day Halo traction,having a posterior correction with instrumentation.(3)18cases underwent anterior strut grafting firstly,then a posterior correction with instrumentation two weeks later.(4)12cases had one-stage anterior epiphysiodesis and posterior correcton of scoliosis.Result:Ttransient neurological deficits during traction occurred in9cases,one had sudden heart arrest during posterior correction(resusci-tated successfully),one had uncomplete paraplegia after posterior correction with instrumentation,perioperative pulmonary complications happened in10.Conclusion:Characterized with rigid curve,obvious trunk shift,heart and pulmonary dysfunction,and neurological deficits,severe scoliosis have a high and serious incidence of pe-rioperative complications.Proper measures may play an efficient role in reducing the perioperative complica-tions.