Deng Youwen, Zhou Yijia, Lu Guohua, Wang Bing, Li Jing, Kang Yijun, Lu Chang, Liu Weidong, Ma Zemin
Department of Spine Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2009 Aug;34(8):820-4.
To analyze the etiology and prevention of complications related to the pedicle screw technique in the treatment of thoracic scoliosis.
There were 183 thoracic deformity patients 110 idiopathic scoliosis, 32 adult scoliosis, 28 congenital kyphoscoliosis, 8 Marfan syndrome with scoliosis, and 6 others. All patients' Cobb angles were evaluated preoperatively, intraoperatively, and postoperatively by roentgenograms. The deformity correction rate was calculated. All radiographic evaluations were carried out in a double-blind fashion. The complication rate was analyzed perioperatively and postoperatively.
The deformity correction rate was 72%, better than others treated with hook-rod system. The perioperation complication rate was 8.4% (pedicle fracture 1.5%, infection 3.8%, pneumothorax and plural effusion 1.6%, transitory neurological damage 0.5%, and over-bleeding shock 1%). The complication rate at follow-up was 3.6% (infection 0.5%, fatigue fracture 1%, loss of deformity correction 1.6%, and transitory neurological damage 0.5%). Compared with those treated with hook-rod system, the perioperation complication rate, loss of deformity correction, permanent damage, and complications related to the internal fixation were all low.
The complication rate of pedicle screw fixation system was low in the treatment of thoracic deformity. When surgeons are thoroughly familiar with the technique and related pathoanatomy, and with the spinal cord function wardship by SEP, complications related to the pedicle screw technique in the treatment of thoracic scoliosis will be well controlled.
分析胸椎侧弯治疗中椎弓根螺钉技术相关并发症的病因及预防措施。
183例胸椎畸形患者，其中特发性脊柱侧弯110例，成人脊柱侧弯32例，先天性脊柱后凸侧弯28例，马凡综合征合并脊柱侧弯8例，其他6例。术前、术中及术后均通过X线片评估所有患者的Cobb角，计算畸形矫正率。所有影像学评估均采用双盲方式进行。分析围手术期及术后的并发症发生率。
畸形矫正率为72%，优于采用钩棒系统治疗的患者。围手术期并发症发生率为8.4%（椎弓根骨折1.5%，感染3.8%，气胸及胸腔积液1.6%，短暂性神经损伤0.5%，出血性休克1%）。随访期并发症发生率为3.6%（感染0.5%，疲劳骨折1%，畸形矫正丢失1.6%，短暂性神经损伤0.5%）。与采用钩棒系统治疗的患者相比，围手术期并发症发生率、畸形矫正丢失、永久性损伤及内固定相关并发症均较低。
椎弓根螺钉固定系统治疗胸椎畸形的并发症发生率较低。当外科医生充分熟悉该技术及相关病理解剖，并通过体感诱发电位监护脊髓功能时，胸椎侧弯治疗中与椎弓根螺钉技术相关的并发症将得到良好控制。
