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后路脊柱椎体切除术的结果:苏克技术的手术改良

Results of Posterior Vertebral Column Resection: Surgical Modification of Suk Technique.

作者信息

Aydinli Ufuk, Kara Kursat, Mutlu Muren, Yaray Osman

机构信息

Verom Spine and Tumor Center, Bursa, Turkey.

İstinye University Medical School, Istanbul, Turkey.

出版信息

Global Spine J. 2018 Aug;8(5):478-482. doi: 10.1177/2192568217739854. Epub 2017 Dec 10.

Abstract

STUDY DESIGN

Consecutive, retrospective review.

OBJECTIVES

To evaluate and report a modified posterior vertebral column technique.

METHODS

We present a retrospective analysis of 20 patients. Patients having severe 3-dimensional deformity with flexibility less than 20% and managed by posterior vertebral body resection (PVCR) between 2011 and 2014 were included in this study. There were 12 female and 8 male patients, with a mean age of 18 year (range = 3-63 years).

RESULTS

The average follow-up was 3.5 years (2-5 years). The preoperative coronal plane deformity was 84° (70° to 120°) and corrected to 42° (28° to 68°), showing 60% scoliosis correction. Average preoperative local kyphotic angle was 92° (82° to 110°). Correction rate for kyphosis was 62%. All patients after surgery showed their baseline neurological status, and no complications were encountered. The mean estimated blood loss was 1072 mL (350-2000 mL). Thirty-nine percent (33% to 50%) of total blood loss occurred after vertebral body resection, and 61% (50% to 67%) blood loss occurred after the removal of posterior elements. The ratio of estimated blood loss to estimated body blood volume was 26% (range = 19% to 52%).

CONCLUSION

We found that 60% of total bleeding occurs during and after posterior bone resection. Spinal cord is open to possible iatrogenic direct spinal cord injury with surgical instruments for a much shorter period of time compared with the original technique.

摘要

研究设计

连续回顾性研究。

目的

评估并报告一种改良的后路脊柱技术。

方法

我们对20例患者进行了回顾性分析。纳入2011年至2014年间接受后路椎体切除术(PVCR)治疗、伴有严重三维畸形且柔韧性小于20%的患者。其中女性12例,男性8例,平均年龄18岁(范围3 - 63岁)。

结果

平均随访3.5年(2 - 5年)。术前冠状面畸形为84°(70°至120°),矫正后为42°(28°至68°),脊柱侧凸矫正率为60%。术前局部后凸角平均为92°(82°至110°)。后凸矫正率为62%。所有患者术后神经功能均保持术前基线状态,未出现并发症。平均估计失血量为1072毫升(350 - 2000毫升)。椎体切除术后发生的失血量占总失血量的39%(33%至50%),后路结构切除术后失血量占61%(50%至67%)。估计失血量与估计血容量的比值为26%(范围19%至52%)。

结论

我们发现,总失血量的60%发生在后部骨切除术中及术后。与原始技术相比,脊髓暴露于手术器械可能造成医源性直接脊髓损伤的时间要短得多。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b921/6149037/c6063464516a/10.1177_2192568217739854-fig1.jpg

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