摘要
目的探讨重度脊柱侧凸手术治疗中神经系统并发症的防治方法。方法手术治疗Cobb 角大于80°的脊柱侧凸患者71例。术前侧凸角平均96.6°(80°～135°),31例患者同时有脊柱后凸,平均后凸角83.0°(52°～145°)。行后路节段椎弓根螺钉同定14例,后路顶椎楔形截骨21例,分期手术34例,前后路联合手术2例。术中应用 SEP 和唤醒试验双向监测61例,单独唤醒试验10例。结果术后平均侧凸角39.6°(矫正率59.2%),平均后凸角31.9°(矫正率61.6%)。39例患者术后平均随访51个月(5～81个月),其中33例患者植骨融合良好,矫正丢失率平均2.1%,2例因内固定断裂再次手术。术前有神经功能障碍的8例患者中,除4例脊髓灰质炎后遗症外,3例完全恢复,1例大部分恢复。术后出现神经功能障碍5例,4例完全恢复,1例部分恢复。结论头颅骨盆环和脊椎截骨技术是提高重度脊柱侧凸矫正率、降低神经并发症的有效方法;术中唤醒试验配合 SEP监测能较早提示神经系统损伤;对出现神经系统损伤患者,术后早期使用脱水药和激素有利于神经功能恢复。
Objective To discuss the prevention and management of the neurological complications during treatment for severe scoliosis. Methods Seventy-one patients with the coronal Cobb angle more than 80° underwent operation. The average coronal Cobb angle was 96. 6° （ 80° - 135° ） , and 31 patients combined with kyphotic deformity with average sagittal Cobb angle 83.0°（ 52° - 145°）. Fourteen patients were treated with posterior pedicle screw fixation alone, 21 combined with posterior wedge resection, 34 with staged operation, and 2 with combined anterior and posterior approach. Intraoperative somatosensory evoked potentials （SEP） monitoring and wake up test were used in 61 cases, and wake up test was used alone in 10 cases. Results The average coronal curve correction was 59. 2% （ average 39.6°） and sagittal curve correction was 61.6% （ average 31.9°）. Thirty-nine patients were followed up with average 51 months （5 -81 months）. Among them, 33 patients achieved solid spinal fusion and the rate of correction loss was 2. 1%. Two patients underwent reoperation because of the breakages of the internal fixation. Among 8 patients with neurological dysfunction pre-operatively, 3 patients obtained complete recovery, 1 patient incomplete recovery, and the rest hadn＇t recovered because of postpoliomyelitis syndrome. Four of 5 patients developed neurological dysfunction post-operatively obtained complete recovery and 1 partial recovery. Conclusions Halo-pelvic distraction and apical vertebra osteotomy are useful for increasing the correction rate and decreasing the neurological dysfunction. Intraoperative SEP monitoring combined with wake up test can call attention to early nerve injury. Early using of glucocorticoids and dehydration therapy promptly post-operatively is benefit to prevent neurological complications.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2007年第8期517-519,共3页
Chinese Journal of Surgery
关键词
脊柱侧凸
治疗
神经系统并发症
防治
Scoliosi＇s
Therapy
Neurological complications
Prevention
