脊柱侧凸后路矫形的并发症比较分析

发布时间：2018-03-13 23:11

  本文选题：脊柱侧凸　切入点：并发症　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的分析后路矫形手术治疗脊柱侧凸的并发症发生率,探讨不同病因学、年龄、性别、BMI、侧凸角度等因素与术后并发症有无关联。方法我们对郑州大学第一附属医院骨外科2010年1月至2016年2月手术治疗的199例脊柱侧凸的患者资料进行回顾性分析。所有患者均行后路脊柱内固定矫形术,男性71例,女性128例,手术时平均年龄15.4岁(10岁~43岁),CS患者61例,AIS 138例。按不同年龄、不同性别、不同的病因学分类、不同Cobb角度(主弯)、不同BMI进行分组,分别统计分析各种类型并发症的发生率。使用脊柱侧凸研究协会(SRS)SRS-22评分评价患者术前、术后的健康相关生存质量(HRQL),记录手术时间、出血量。应用Cobb角法测定术前和末次随访时的侧凸角度。结果患者平均随访4年(1.5年~5.5年),手术平均时长258min,平均出血量1028ml术前平均Cobb角度为65.78°±28.37°,术后末次随访平均Cobb角度为24.35°±7.58°,矫正率为62.98%。术前患者SRS-22评分平均为63.78±14.86,末次随访为82.63±6.86。总共发生并发症发生26例,并发症发生率为13.06%,切口术后渗液13例,发生率为6.53%;术后感染3例,发病率1.5%;神经并发症4例,发生率2.01%;脑脊液漏1例,发生率0.5%;有5例患者行翻修手术,发生率2.51%。CS组患者神经并发症发生率为6.56%,高于AIS组的0(P0.05),两者有统计学差异,先天性脊柱侧凸(CS)总体并发症发生率为21.31%,高于特发性脊柱侧凸(AIS)的9.42%,两者差异有统计学意义,本组其他并发症发病率无统计学差异。BMI18.5组的患者,切口渗液发生率为9.65%,高于BMI≥18.5的患者2.35%(P0.05),两者有统计学差异,本组其他并发症发病率无统计学差异。Cobb角(主弯)≥90°组患者的神经并发症发生率为7.01%,高于Cobb角90°(主弯)组的0(P0.05),两者有统计学差异,其他并发症发生率无统计学差异。不同性别及年龄的患者所有并发症发生率均无统计学差异。结论经后路手术治疗脊柱侧凸效果较好,并有较高的患者满意度。CS术后神经并发症发生率高于AIS组,CS组总的并发症发生率高于AIS组;Cobb角(主弯)≥90°组患者神经并发症发生率高于Cobb角(主弯)小于90°组患者,BMI18.5组的患者切口渗液发生率高于BMI≥18.5组的患者。在没有电生理监测条件下行脊柱矫形手术时,对于CS和主弯Cobb角大于90°以上的患者,医生应更加小心,谨防出现神经并发症;对于CS患者应在手术期间与术后都应更加关注;对于营养不良患者(BMI18.5),术中应加强切口缝合密度,使用可吸收线缝合切口,术后应关注患者血白蛋白和总蛋白指标,加强患者营养支持治疗,防止切口渗液发生,预防感染。
[Abstract]:Objective to analyze the incidence of complications of posterior orthopaedic surgery for scoliosis, and to explore the different etiology and age of scoliosis. Methods the data of 199 patients with scoliosis treated by surgery from January 2010 to February 2016 in the first affiliated Hospital of Zhengzhou University were retrospectively analyzed. All patients underwent posterior spinal internal fixation orthopedics, There were 71 males and 128 females. The mean age at the time of operation was 15.4 years old or 10 years old or 43 years old with CS. According to different age, sex, different etiology classification, different Cobb angle (main curvature, different BMI) were divided into two groups. The incidence of various types of complications was statistically analyzed. The SRSS-22 score was used to evaluate the preoperative and postoperative health-related quality of life (HQL) and to record the time of operation. Bleeding volume. The angle of scoliosis was measured by Cobb angle method. Results the mean follow-up time was 4 years (1.5 ~ 5.5 years), the average operative time was 258 minutes, the mean preoperative Cobb angle was 1028ml, and the last follow-up was 65.78 掳卤28.37 掳. The Cobb angle was 24.35 掳卤7.58 掳and the correction rate was 62.98. The average SRS-22 score of the patients before operation was 63.78 卤14.86, and the last follow-up was 82.63 卤6.86.The complications occurred in 26 cases. The incidence of complications was 13.06%, 13 cases were exudate after incision, the incidence rate was 6.53; there were 3 cases of postoperative infection and 1.5 cases of morbidity; 4 cases of neurological complications, the incidence rate of 2.01%; 1 case of cerebrospinal fluid leakage (0.5%); 5 cases of revision operation; The incidence of neurologic complications in CS group was 6.56, which was higher than that in AIS group (P 0.05). There was statistical difference between the two groups. The overall complication rate of CSS in congenital scoliosis was 21.31%, which was higher than 9.42% in idiopathic scoliosis group (AIS), and the difference was statistically significant. There was no statistical difference in the incidence of other complications. The incidence of incision exudation was 9.65 in the group of BMI18.5, which was higher than that in the group with BMI 鈮，

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