后路全脊椎截骨术治疗重度先天性脊柱畸形并发症分析及术中体感诱发电位监测的应用
发布时间：2018-11-12 06:44
【摘要】：目的:分析后路全脊椎截骨治疗严重僵硬性先天性脊柱畸形的并发症,探讨术中体感诱发电位监测的应用价值。方法:2007年6月至2012年11月,88例严重僵硬性脊柱畸形患者在我院接受后路全脊椎截骨治疗。男性39例,女性49例,年龄6~46岁,平均(17±7)岁。先天性侧凸18例,先天性侧后凸63例,先天性后凸7例。27例合并椎管内畸形,15例术前神经功能异常,25例肺功能异常。测量患者术前、术后及随访时Cobb角、平衡情况,记录手术情况、术中神经电生理监测情况、神经并发症及随访情况等。分析并发症发生率,探讨发生神经系统并发症的高危因素。并分析体感诱发电位波幅变化率与手术因素的相关性。结果:所有患者随访24~88个月,平均47个月。切除椎体1~3个,平均1.3个,固定椎体数3~16个,平均10.9个,手术时间165.0~880.0min,平均(502.4±170.3)min,出血量100~11500ml,平均(2238±2214)ml,出血比9%~299%,平均69.3%。冠状位Cobb角由术前平均93.6°±25.1°矫正至22.2°±13.1°,末次随访22.9°±13.2°,矫形率76.8%。冠状位失衡(绝对值)由术前平均2.5cm减少至1.3cm。矢状位Cobb角由术前平均88.2°±25.6°矫正至28.7°±16.9°,末次随访29.2°±17.0°,矢状位Cobb角平均减少59.0°±16.8°。矢状位失衡(绝对值)由术前平均3.1cm减少至1.2cm。术中术后并发症共计42例(47.7%),术中并发症40例(45.5%),包括出血比50%37例(42.0%),胸膜破裂1例(1.1%)、硬膜破裂1例(1.1%)及术中神经电生理监测异常12例(13.6%);术后并发症24例(27.3%),包括上呼吸道感染2例(2.3%)、肺部感染并胸腔积液1例(1.1%)、泌尿系感染1例(1.1%)、苏醒延迟7例(8.0%)、肺膨胀不良1例(1.1%)、脑脊液漏1例(1.1%)、一过性呼吸困难1例(1.1%)、神经并发症12例(13.6%)。手术时间≥480 min、肺功能异常、出血比50%、T7~T9截骨及术前神经功能异常患者神经并发症发生率较高(P=0.046,0.000,0.000,0.033,0.043)。12例患者出现术中体感诱发电位监测异常,敏感性83.3%,特异性97.4%,假阳性率2.6%,假阴性率16.7%。手术时间、出血比、固定节段与术中体感诱发电位监测波幅的下降率存在直线相关(p=0.000,0.000,0.000),出血比影响最大。结论:后路全脊椎截骨治疗严重僵硬性先天性脊柱畸形能够获得满意的疗效。肺功能异常、出血比50%是其神经并发症的高危因素;术中体感诱发电位监测敏感性较高,但影响因素多、单独使用存在缺陷,因此需要合理的联合使用多种监测手段。
[Abstract]:Objective: to analyze the complications of posterior total spinal osteotomy in the treatment of severe rigid congenital spinal deformity and to explore the value of monitoring somatosensory evoked potentials (SEP) during operation. Methods: from June 2007 to November 2012, 88 patients with severe stiff spinal deformity were treated with posterior total spinal osteotomy in our hospital. Male 39 cases, female 49 cases, age 646 years, mean (17 卤7) years old. There were 18 cases of congenital scoliosis, 63 cases of congenital scoliosis, 7 cases of congenital kyphosis, 27 cases of intraspinal malformation, 15 cases of preoperative neurological dysfunction and 25 cases of pulmonary dysfunction. The Cobb angle, balance, operation, intraoperative electrophysiological monitoring, neurologic complications and follow-up were measured. To analyze the incidence of complications and explore the high risk factors of neurological complications. The correlation between the amplitude of somatosensory evoked potential (SEP) and surgical factors was analyzed. Results: all patients were followed up for 24 ~ 88 months (mean 47 months). The number of fixed vertebrae was 3 ~ 16 (mean 10.9). The operative time was 165.0 ~ 880.0min, and the average bleeding volume of (502.4 卤170.3) min, was 100 ~ 11500 ml, the average ml, bleeding was (2238 卤2214) ml,. The coronal Cobb angle was corrected from 93.6 掳卤25.1 掳to 22.2 掳卤13.1 掳, and the last follow-up was 22.9 掳卤13.2 掳. The coronal imbalance (absolute value) was reduced from preoperative mean 2.5cm to 1.3 cm. The sagittal Cobb angle was corrected from 88.2 掳卤25.6 掳to 28.7 掳卤16.9 掳, the last follow-up was 29.2 掳卤17.0 掳, and the sagittal Cobb angle was reduced by 59.0 掳卤16.8 掳. Sagittal imbalance (absolute value) was reduced from preoperative mean 3.1cm to 1.2 cm. There were 42 cases (47.7%) of intraoperative complications, 40 cases (45.5%) of intraoperative complications, including 507 cases (42.0%) of bleeding, 1 case (1.1%) of pleural rupture. Dural rupture occurred in 1 case (1.1%) and abnormal neurophysiological monitoring in 12 cases (13.6%). Postoperative complications were found in 24 cases (27.3%), including upper respiratory tract infection in 2 cases (2.3%), pulmonary infection with pleural effusion in 1 case (1.1%), urinary tract infection in 1 case (1.1%), delayed recovery in 7 cases (8.0%). Pulmonary dyspnea was found in 1 case (1.1%), cerebrospinal fluid leakage in 1 case (1.1%), transient dyspnea in 1 case (1.1%), neurological complications in 12 cases (13.6%). The incidence of neurologic complications was higher in patients with abnormal pulmonary function than 50% T7 / T9 osteotomy and preoperative neurologic dysfunction (P0. 046 / 0. 0000.0000.000 / 0. 03 / 0.043). 12 patients had abnormal monitoring of somatosensory evoked potentials (SEP) during the operation, and 12 patients had abnormal monitoring of somatosensory evoked potentials (SEP) during operation. Sensitivity 83.3%, specificity 97.4%, false positive rate 2.6%, false negative rate 16.7%. There was a linear correlation between the operation time, bleeding ratio and fixed segment and the decrease rate of somatosensory evoked potential monitoring amplitude during the operation (P < 0.000 ~ 0.000 ~ 0.000), and the bleeding ratio was the most significant. Conclusion: posterior total spinal osteotomy can achieve satisfactory results in the treatment of severe rigid congenital spinal deformity. Abnormal lung function and 50% bleeding ratio were the high risk factors for neurological complications. The sensitivity of somatosensory evoked potential monitoring was high, but there were many influencing factors, so it was necessary to use a reasonable combination of multiple monitoring methods.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：2326346
[Abstract]:Objective: to analyze the complications of posterior total spinal osteotomy in the treatment of severe rigid congenital spinal deformity and to explore the value of monitoring somatosensory evoked potentials (SEP) during operation. Methods: from June 2007 to November 2012, 88 patients with severe stiff spinal deformity were treated with posterior total spinal osteotomy in our hospital. Male 39 cases, female 49 cases, age 646 years, mean (17 卤7) years old. There were 18 cases of congenital scoliosis, 63 cases of congenital scoliosis, 7 cases of congenital kyphosis, 27 cases of intraspinal malformation, 15 cases of preoperative neurological dysfunction and 25 cases of pulmonary dysfunction. The Cobb angle, balance, operation, intraoperative electrophysiological monitoring, neurologic complications and follow-up were measured. To analyze the incidence of complications and explore the high risk factors of neurological complications. The correlation between the amplitude of somatosensory evoked potential (SEP) and surgical factors was analyzed. Results: all patients were followed up for 24 ~ 88 months (mean 47 months). The number of fixed vertebrae was 3 ~ 16 (mean 10.9). The operative time was 165.0 ~ 880.0min, and the average bleeding volume of (502.4 卤170.3) min, was 100 ~ 11500 ml, the average ml, bleeding was (2238 卤2214) ml,. The coronal Cobb angle was corrected from 93.6 掳卤25.1 掳to 22.2 掳卤13.1 掳, and the last follow-up was 22.9 掳卤13.2 掳. The coronal imbalance (absolute value) was reduced from preoperative mean 2.5cm to 1.3 cm. The sagittal Cobb angle was corrected from 88.2 掳卤25.6 掳to 28.7 掳卤16.9 掳, the last follow-up was 29.2 掳卤17.0 掳, and the sagittal Cobb angle was reduced by 59.0 掳卤16.8 掳. Sagittal imbalance (absolute value) was reduced from preoperative mean 3.1cm to 1.2 cm. There were 42 cases (47.7%) of intraoperative complications, 40 cases (45.5%) of intraoperative complications, including 507 cases (42.0%) of bleeding, 1 case (1.1%) of pleural rupture. Dural rupture occurred in 1 case (1.1%) and abnormal neurophysiological monitoring in 12 cases (13.6%). Postoperative complications were found in 24 cases (27.3%), including upper respiratory tract infection in 2 cases (2.3%), pulmonary infection with pleural effusion in 1 case (1.1%), urinary tract infection in 1 case (1.1%), delayed recovery in 7 cases (8.0%). Pulmonary dyspnea was found in 1 case (1.1%), cerebrospinal fluid leakage in 1 case (1.1%), transient dyspnea in 1 case (1.1%), neurological complications in 12 cases (13.6%). The incidence of neurologic complications was higher in patients with abnormal pulmonary function than 50% T7 / T9 osteotomy and preoperative neurologic dysfunction (P0. 046 / 0. 0000.0000.000 / 0. 03 / 0.043). 12 patients had abnormal monitoring of somatosensory evoked potentials (SEP) during the operation, and 12 patients had abnormal monitoring of somatosensory evoked potentials (SEP) during operation. Sensitivity 83.3%, specificity 97.4%, false positive rate 2.6%, false negative rate 16.7%. There was a linear correlation between the operation time, bleeding ratio and fixed segment and the decrease rate of somatosensory evoked potential monitoring amplitude during the operation (P < 0.000 ~ 0.000 ~ 0.000), and the bleeding ratio was the most significant. Conclusion: posterior total spinal osteotomy can achieve satisfactory results in the treatment of severe rigid congenital spinal deformity. Abnormal lung function and 50% bleeding ratio were the high risk factors for neurological complications. The sensitivity of somatosensory evoked potential monitoring was high, but there were many influencing factors, so it was necessary to use a reasonable combination of multiple monitoring methods.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
【参考文献】
相关期刊论文 前1条
1 杨军林;黄紫房;邓耀龙;李佛保;舒海华;陈裕光;魏明;刘卫锋;孙新锐;;SSEP、MEP和DNEP在重度脊柱畸形截骨矫形术中同时联合监测的意义[J];脊柱外科杂志;2011年06期
，本文编号：2326346
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