Aydinli Ufuk, Kara Kursat, Mutlu Muren, Yaray Osman
Verom Spine and Tumor Center, Bursa, Turkey.
İstinye University Medical School, Istanbul, Turkey.
Global Spine J. 2018 Aug;8(5):478-482. doi: 10.1177/2192568217739854. Epub 2017 Dec 10.
Consecutive, retrospective review.
To evaluate and report a modified posterior vertebral column technique.
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).
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%).
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.
连续回顾性研究。
评估并报告一种改良的后路脊柱技术。
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)。
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%)。
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。