退行性脊柱侧凸术后翻修原因及危险因素

发布时间：2018-01-22 20:28

本文关键词： 退行性脊柱侧凸翻修外科手术　出处：《中国脊柱脊髓杂志》2016年08期 　论文类型：期刊论文

【摘要】：目的:探讨退行性脊柱侧凸术后翻修的原因及相关危险因素。方法:回顾性研究2010年1月~2013年12月于我院手术治疗的132例退行性脊柱侧凸患者的临床及影像学资料,所有患者采用单一后路手术、融合范围5个椎体或以上、随访时间至少2年。其中男49例,女83例;年龄40~78岁,平均61.8±15岁。手术节段5~14个椎体,平均7.9±1.8个椎体。随访时间2~5年,平均3.7±1.2年。60例上位固定椎选择于T10或以上,72例选择于T10以下;69例下位固定椎选择于L5,63例选择于骶骨或髂骨;采用三柱截骨37例。统计翻修率,并分析不同翻修原因的危险因素。结果:132例中共15例17个并发症行翻修手术,翻修率11.4%。其中男5例,女10例;年龄41~75岁,平均59±17岁。翻修原因包括近端交界区并发症占29.4%(5/17),假关节形成或内置物断裂占23.5%(4/17),冠状位及矢状位失平衡各占11.8%(2/17),远端交界区并发症占11.8%(2/17),椎弓根螺钉误置、急性期深部创口感染各5.9%(1/17)。性别、年龄与翻修率无显著相关(χ~2=0.104,P=0.747,χ~2=0.151,P=0.698);上位固定椎选择与近端交界区并发症无显著相关(χ~2=0.063,P=0.802);下位固定椎选择于骶骨或髂骨组的近端交界区并发症翻修率较L5组显著增加(χ~2=2.033,P=0.041);三柱截骨组棒断裂、冠状位失平衡较未行三柱截骨组显著增加(χ~2=5.214,P=0.022)。结论:退行性脊柱侧凸术后翻修的主要原因包括近端交界区并发症、假关节形成或内置物断裂以及脊柱失平衡;三柱截骨会增加棒断裂及冠状位失平衡;融合至骶骨或髂骨会增加近端交界区并发症。
[Abstract]:Objective: to investigate the causes and related risk factors of postoperative revision of degenerative scoliosis. The clinical and imaging data of 132 cases of degenerative scoliosis treated in our hospital from January 2010 to December 2013 were retrospectively studied. All the patients were operated by single posterior approach with fusion of 5 or more vertebrae. The follow-up time was at least 2 years. There were 49 males and 83 females. The age was 4078 years (mean 61.8 卤15 years). The operative segments ranged from 514 vertebrae to 14 vertebrae, with an average of 7.9 卤1.8 vertebrae. The follow-up time was 2 to 5 years. The mean value was 3.7 卤1.2 years. 60 cases of epigastric fixation were selected in T10 or above. 72 cases were selected under T10. 69 cases of lower fixation were selected from L5N 63 cases from sacrum or ilium. Three column osteotomy was performed in 37 cases. The revision rate was calculated and the risk factors of different revision causes were analyzed. Results revision operation was performed in 15 cases (17 complications) of 132 cases with revision rate of 11.4% (5 males). Female 10 cases; The age was 41 to 75 years (mean 59 卤17 years). The causes of revision included complications in proximal junction area (29.4 / 17), pseudoarticular formation or interbody rupture (23.55-4 / 17). Coronal and sagittal disequilibrium accounted for 11.8 / 17, distal junction complications accounted for 11.8 / 17, pedicle screw misplacement. There was no significant correlation between sex, age and revision rate (蠂 ~ 2 / 0.104, P ~ (0.747), 蠂 ~ (2 +) = 0.151). P0. 698; There was no significant correlation between the choice of upper fixation vertebrae and the complications of proximal junction (蠂 ~ (2) 0.063 ~ (0.802)). The incidence of complications in the proximal junction of the sacrum or iliac bone fixation group was significantly higher than that in the L5 group (蠂 ~ 2 / 2 / 03 ~ (3) P = 0.041). The rod fracture and coronal disequilibrium in the three-column osteotomy group were significantly higher than those in the non-three-column osteotomy group (蠂 ~ 2 + 2) 5.214. Conclusion: the main causes of revision of degenerative scoliosis include proximal junction complications, pseudoarticular formation or interposition rupture, and spinal imbalance. Tri-column osteotomy increased rod fracture and coronal imbalance. Fusion to the sacrum or ilium increases complications in the proximal junction.
【作者单位】：浙江大学医学院附属第二医院脊柱外科;
【基金】：国家自然科学基金(项目编号:81572177)
【分类号】：R687.3
【正文快照】： 退行性脊柱侧凸临床症状包括腰痛、下肢神经症状以及功能障碍,对于保守治疗无效患者,手术是目前常用的治疗方法,可显著减轻患者的疼痛、提高患者的生活质量[1~3]。但是,此类手术具有较高的并发症发生率,一些患者甚至不得不再次手术。文献报道多数为成人脊柱畸形的并发症及再手

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