学术论文

      长、短节段融合内固定治疗成人退变性脊柱侧凸并发症分析

      An analysis of complications after long-segment versus short-segment ifxation and fusion for adult degenerative

      摘要:
      目的:探讨长、短节段融合内固定治疗退变性脊柱侧凸( degenerative scoliosis,DS )的并发症。方法回顾性研究2007年1月至2012年2月,我院收治的94例 DS 并接受后路融合手术患者的临床及影像学资料。其中,长节段固定66例(70.2%),男11例,女55例,平均年龄(59.1±9.9)岁,术前侧凸Cobb’s角平均(39.3±9.1)°;短节段固定28例(29.8%),男5例,女23例,平均年龄(62.7±12.3)岁,术前侧凸Cobb’s角平均(18.5±6.4)°。评估指标:年龄、性别、减压节段、融合节段、术中出血量、手术时间、术后住院时间,冠状面Cobb’s角及整体平衡状态,早期(<术后3个月)和晚期(≥术后3个月)并发症所占比例。结果两组在年龄、性别及减压节段上差异无统计学意义( P=0.081、0.412和0.067)。长节段融合固定组平均融合固定节段(11.1±5.5)个,术后侧凸Cobb’s角平均(13.3±6.5) °;短节段融合固定组平均融合固定节段(3.8±3.2)个,术后侧凸Cobb’s角平均(8.8±6.7) °。长节段固定组的手术时间、术中出血量以及术后住院时间[分别为(260.8±35.6) min,(2788.0±63.8) ml,(6.7±5.5)天]明显大于短节段固定组[分别为(188.3±20.7) min,(1642.0±49.9) ml,(4.9±3.8)天],差异有统计学意义( P<0.05)。长节段固定组早期、晚期及总体并发症发生率分别为9.1%、28.8%和37.9%;短节段固定组早期、晚期及总体并发症发生率分别为3.6%、25.0%和28.6%。长节段固定组最常见的并发症为内固定断裂(8例,12.1%)与冠状面整体失平衡(6例,9.1%);短节段固定组则易出现侧凸进展(2例,7.1%)与近端临近节段病变(2例,7.1%)。结论虽然短节段融合内固定围手术期并发症发生率低,但易出现侧凸进展、临近节段退变等并发症;长节段融合内固定虽然能够显著改善畸形,但手术时间长、术中出血量大,远期随访过程中出现躯干倾斜及断棒等并发症的风险较高。
      Abstract:
      Objective To investigate the complications following long-segment versus short-segment fixation and fusion for degenerative scoliosis ( DS ). Methods From January 2007 to February 2012, 94 patients with DS underwent posterior spinal fusion, whose clinical and imaging data were retrospectively reviewed. Long-segment ifxation was performed on 66 patients ( 70.2%). There were 11 males and 55 females, whose mean age was ( 59.1±9.9 ) years old and mean preoperative Cobb’s angle was ( 39.3±9.1 ) °. Short-segment ifxation was performed on 28 patients ( 29.8%). There were 5 males and 23 females, whose mean age was ( 62.7±12.3 ) years old and mean preoperative Cobb’s angle was ( 18.5±6.4 ) °. Hospital records were reviewed for the patients’ age, gender, number of decompression and fusion levels, intraoperative blood loss, operation time, postoperative hospital stay, coronal Cobb’s angle, coronal and sagittal balance, early perioperative complications (<3 months after the surgery ) and late complications (≥3 months after the surgery ). Results No statistically signiifcant differences existed between the 2 groups in the age ( P=0.081 ), gender ( P=0.412 ) and number of decompression levels ( P=0.067 ). The average numbers of fusion levels were 11.1±5.5 in the long-segment fusion group and 3.8±3.2 in the short-segment fusion group. The mean postoperative Cobb’s angles were ( 13.3±6.5 ) ° and ( 8.8±6.7 )° respectively in each group. The mean operation time and postoperative hospital stay were ( 260.8±35.6 ) min and ( 6.7±5.5 ) days in the long-segment fusion group, which were obviously longer than ( 188.3±20.7 ) min and ( 4.9±3.8 ) days in the short-segment fusion group. There were statistically signiifcant differences between the 2 groups ( P<0.01 ). The mean blood loss was ( 2788.0± 63.8 ) ml in the long-segment fusion group, which was obviously greater than ( 1642.0±49.9 ) ml in the short-segment fusion group. There were statistically signiifcant differences between the 2 groups ( P<0.01 ). The incidences of early complications, late complications and overall complications were 9.1%, 28.8%and 37.9%in the long-segment fusion group and 3.6%, 25.0%, 28.6% in the short-segment fusion group respectively. The most common complications included the breakage of internal ifxation ( 8 cases, 12.1%) and coronal imbalance ( 6 cases, 9.1%) in the long-segment fusion group, while, curve progression ( 2 cases, 7.1%) and proximal adjacent segment disease ( 2 cases, 7.1%) were more common in short-segment fusion group. Conclusions Although the incidence of perioperative complications is lower in the short-segment fusion group, curve progression and proximal adjacent segment disease frequently occur. Deformity can be signiifcantly improved with the treatment of long-segment fusion, but the risk of trunk lean and rod fracture is higher in the long-term follow-up, with longer operation time and greater intraoperative blood loss.
      Author: scoliosis HE Shou-yu ZHU Feng QIU Yong ZHU Ze-zhang SUN Xu BAO Hong-da ZHOU Heng-cai QIAO Jun
      作者单位: 南京大学医学院附属鼓楼医院脊柱外科, 江苏,210008
      刊 名: 中国骨与关节杂志 ISTIC
      年,卷(期): 2015, (3)
      分类号: R682.3
      机标分类号: R68 R52
      在线出版日期: 2015年4月9日
      基金项目: 卫生部公益性行业专项资助