马方综合征脊柱侧凸手术并发症分析
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摘要
背景:马方综合征脊柱畸形矫形手术比较复杂,针对此类手术并发症的报道并不多。目的:分析马方综合征脊柱侧凸(MSS)患者接受矫形手术的并发症发生情况。方法:回顾性分析2002年1月至2012年12月在我院接受矫形手术的MSS患者,对其中37例年龄在10～20岁的初次手术患者进行分析,其中男12例,女25例,平均年龄(15.0±2.7)岁。记录其手术并发症发生情况及转归。结果:本研究患者随访6~96个月,平均(25.7±22.5)个月。手术方式包括分期前路松解加后路矫形2例,一期前路松解加后路矫形1例,前路胸腔镜下器械矫形1例,其余患者均采用单一后路矫形手术。8例患者发生并发症,包括椎弓根螺钉植入时发生脑脊液漏1例,改在其他节段置钉;自发性气胸1例,予以放置胸腔引流管治疗好转;胸腔镜下胸弯融合后腰弯加重并远端交界性后凸1例,行翻修手术,延长融合节段至腰椎;腰弯未融合,随访时腰弯大并远端交界性后凸1例,随访观察中;近端交界性后凸1例,随访观察中;冠状面躯干失代偿1例,随访观察中;椎弓根螺钉断裂1例,行翻修手术,重置椎弓根螺钉;椎弓根螺钉位置异常导致神经并发症1例,予以探查、减压翻修手术,神经功能恢复正常。结论:马方综合征脊柱侧凸患者椎弓根发育差,植入椎弓根螺钉时易发生螺钉位置异常而导致并发症;此类患者融合节段不当易发生冠状面失代偿及矢状面交界性后凸。
Background: The correction surgery of Marfan syndrome scoliosis is quite complicated,and there lacks the report of complication after correction surgery in these patients. Objectives: To analyze the complications of patients with Marfan syndrome scoliosis(MSS) after spinal deformity correction surgery. Methods: MSS patients who underwent primary spinal deformity correction surgery in our hospital from January 2002 to December 2012 were retrospectively reviewed and 37 MSS patients aging from 10 to 20 years with an average age of(15.0±2.7) years were enrolled including 12 males and 25 females. The complications and their prognosis were recorded. Results: The patients were followed up for 6-96 months with an average of(25.7±22.5) months. Two patients received staged anterior release and posterior correction, 1 patient received one stage anterior release and posterior correction, 1 patient received video-assisted thoracoscopic surgery with instrumentation and the other patients received only posterior correction surgeries. Complications were found in 8 patients, which included cerebro-spinal fluid leakage during pedicle screw insertion in 1 patient treated by change of the insertion to other pedicle; spontaneous pneumothorax in 1 patient cured by closed thoracic drainage; lumbar curve adding-on after video-assisted thoracoscopic anterior thoracic instrumentation and fusion with distal junctional kyphosis in 1 patient treated by revision surgery and extending the fusion level to the lumbar curve; deterioration of the unfused lumbar curve with distal junctional kyphosis in 1 patient treated with closed follow-up; proximal junctional kyphosis in 1 patient treated with closed follow-up; coronal trunk decompensation in 1 patient treated with closed follow-up; pedicle screw breakage in 1 patient treated with revision surgery and reinsertion of the screw, and neural complication due to improper pedicle screw insertion in 1 patient cured by exploration and decompression surgery. Conclusions: The pedicles of MSS patients are very thin thus the pedicle screws are easy to be dislocated during the insertion which causes complications. In such patients coronal decompensation and junctional kyphosis are prone to occur when the fusion levels are improperly selected.
Background: The correction surgery of Marfan syndrome scoliosis is quite complicated,and there lacks the report of complication after correction surgery in these patients. Objectives: To analyze the complications of patients with Marfan syndrome scoliosis(MSS) after spinal deformity correction surgery. Methods: MSS patients who underwent primary spinal deformity correction surgery in our hospital from January 2002 to December 2012 were retrospectively reviewed and 37 MSS patients aging from 10 to 20 years with an average age of(15.0±2.7) years were enrolled including 12 males and 25 females. The complications and their prognosis were recorded. Results: The patients were followed up for 6-96 months with an average of(25.7±22.5) months. Two patients received staged anterior release and posterior correction, 1 patient received one stage anterior release and posterior correction, 1 patient received video-assisted thoracoscopic surgery with instrumentation and the other patients received only posterior correction surgeries. Complications were found in 8 patients, which included cerebro-spinal fluid leakage during pedicle screw insertion in 1 patient treated by change of the insertion to other pedicle; spontaneous pneumothorax in 1 patient cured by closed thoracic drainage; lumbar curve adding-on after video-assisted thoracoscopic anterior thoracic instrumentation and fusion with distal junctional kyphosis in 1 patient treated by revision surgery and extending the fusion level to the lumbar curve; deterioration of the unfused lumbar curve with distal junctional kyphosis in 1 patient treated with closed follow-up; proximal junctional kyphosis in 1 patient treated with closed follow-up; coronal trunk decompensation in 1 patient treated with closed follow-up; pedicle screw breakage in 1 patient treated with revision surgery and reinsertion of the screw, and neural complication due to improper pedicle screw insertion in 1 patient cured by exploration and decompression surgery. Conclusions: The pedicles of MSS patients are very thin thus the pedicle screws are easy to be dislocated during the insertion which causes complications. In such patients coronal decompensation and junctional kyphosis are prone to occur when the fusion levels are improperly selected.
引文
[1] De Paepe A, Devereux RB, Dietz HC, et al. Revised diagnostic criteria for the Marfan syndrome. Am J Med Genet, 1996,62(4):417-426.
[2] Sponseller PD, Bhimani M, Solacoff D, et al. Results of brace treatment of scoliosis in Marfan syndrome. Spine, 2000, 25(18):2350-2354.
[3] Robins PR, Moe JH, Winter RB. Scoliosis in Marfan's syndrome. Its characteristics and results of treatment in thirtyfive patients. J Bone Joint Surg Am, 1975, 57(3):358-368.
[4]王冰,吕国华,李启贤,等.马方综合征合并脊柱侧弯畸形的外科治疗.湖南医科大学学报,2002,27(5):448-450.
[5] Lipton GE, Guille JT, Kumar SJ. Surgical treatment of scolio-sis in Marfan syndrome:guidelines for a successful outcome.J Pediatr Orthop, 2002, 22(3):302-307.
6] Jones KB, Erkula G, Sponseller PD, et al. Spine deformity correction in Marfan syndrome. Spine, 2002, 27(18):2003-2012.
[7]张学军,于凤章,孙琳,等.Marfan's综合征合并小儿脊柱侧凸的外科治疗探讨.中华小儿外科杂志,2003, 24(1):26-28.
[8] Di Silvestre M, Greggi T, Giacomini S, et al. Surgical treatment for scoliosis in Marfan syndrome. Spine, 2005, 30(20):E597-E604.
[9] Li ZC, Liu ZD, Dai LY. Surgical treatment of scoliosis associated with Marfan syndrome by using posterior-only instrumentation. J Pediatr Orthop B, 2011, 20(2):63-66.
[10] Gjolaj JP, Sponseller PD, Shah SA, et al. Spinal deformity correction in Marfan syndrome versus adolescent idiopathic scoliosis:learning from the differences. Spine, 2012, 37(18):1558-1565.
[11] Zenner J, Hitzl W, Meier O, et al. Surgical outcomes of scoliosis surgery in Marfan syndrome. J Spinal Disord Tech, 2014,27(1):48-58.
[12] Liang W, Yu B, Wang Y, et al. Comparison of posterior correction results between Marfan syndrome scoliosis and adolescent idiopathic scoliosis-a retrospective case-series study. J Orthop Surg Res, 2015, 10:73.
[13] Levy BJ, Schulz JF, Fornari ED, et al. Complications associated with surgical repair of syndromic scoliosis. Scoliosis,2015, 10:14.
[14] Qiao J, Xu L, Liu Z, et al. Surgical treatment of scoliosis in Marfan syndrome:outcomes and complications. Eur Spine J,2016,25(10):3288-3293.
[15] Dietz HC, Cutting GR, Pyeritz RE, et al. Marfan syndrome caused by a recurrent de novo missense mutation in the fi-brillin gene. Nature, 1991, 352(6333):337-339.
[16] Zhao F, Pan X, Zhao K, et al. Two novel mutations of fibrillin-1 gene correlate with different phenotypes of Marfan syndrome in Chinese families. Mol Vis, 2013, 19:751-758.
[17] Hall JR, Pyeritz RE, Dudgeon DL, et al. Pneumothorax in the Marfan syndrome:prevalence and therapy. Ann Thorac Surg,1984, 37(6):500-504.
[18] Wood JR, Bellamy D, Child AH, et al. Pulmonary disease in patients with Marfan syndrome. Thorax, 1984, 39(10):780-784.
[19]刘广源,沈建雄,邱贵兴.马凡综合征合并脊柱侧弯术后自发性气胸一例报告.脊柱外科杂志,2004, 2(5):310-313.
[20] Kim YJ, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion:minimum 5-year follow-up. Spine, 2005, 30(18):2045-2050.
[21] Kim HJ, Bridwell KH, Lenke LG, et al. Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections. Spine, 2014, 39(9):E576-E580.
[22] Lowe TG, Lenke L, Betz R, et al. Distal junctional kyphosis of adolescent idiopathic thoracic scoliosis following anterior or posterior instrumented fusion:incidence, risk factors, and prevention. Spine, 2006, 31(3):299-302.
[23]邱勇,夏才伟,王斌,等.青少年特发性胸椎侧凸选择性融合术后的远端交界性后凸.中华骨科杂志,2009, 29(2):117-122.
[24] Sponseller PD, Ahn NU, Ahn UM, et al. Osseous anatomy of the lumbosacral spine in Marfan syndrome. Spine, 2000, 25(21):2797-2802.
[25] Jun Qiao, Feng Zhu, Leilei Xu, et al. Accuracy of pedicle screw placement in patients with Marfan syndrome. BMC Musculoskelet Disord, 2017, 18(1):123.
[2] Sponseller PD, Bhimani M, Solacoff D, et al. Results of brace treatment of scoliosis in Marfan syndrome. Spine, 2000, 25(18):2350-2354.
[3] Robins PR, Moe JH, Winter RB. Scoliosis in Marfan's syndrome. Its characteristics and results of treatment in thirtyfive patients. J Bone Joint Surg Am, 1975, 57(3):358-368.
[4]王冰,吕国华,李启贤,等.马方综合征合并脊柱侧弯畸形的外科治疗.湖南医科大学学报,2002,27(5):448-450.
[5] Lipton GE, Guille JT, Kumar SJ. Surgical treatment of scolio-sis in Marfan syndrome:guidelines for a successful outcome.J Pediatr Orthop, 2002, 22(3):302-307.
6] Jones KB, Erkula G, Sponseller PD, et al. Spine deformity correction in Marfan syndrome. Spine, 2002, 27(18):2003-2012.
[7]张学军,于凤章,孙琳,等.Marfan's综合征合并小儿脊柱侧凸的外科治疗探讨.中华小儿外科杂志,2003, 24(1):26-28.
[8] Di Silvestre M, Greggi T, Giacomini S, et al. Surgical treatment for scoliosis in Marfan syndrome. Spine, 2005, 30(20):E597-E604.
[9] Li ZC, Liu ZD, Dai LY. Surgical treatment of scoliosis associated with Marfan syndrome by using posterior-only instrumentation. J Pediatr Orthop B, 2011, 20(2):63-66.
[10] Gjolaj JP, Sponseller PD, Shah SA, et al. Spinal deformity correction in Marfan syndrome versus adolescent idiopathic scoliosis:learning from the differences. Spine, 2012, 37(18):1558-1565.
[11] Zenner J, Hitzl W, Meier O, et al. Surgical outcomes of scoliosis surgery in Marfan syndrome. J Spinal Disord Tech, 2014,27(1):48-58.
[12] Liang W, Yu B, Wang Y, et al. Comparison of posterior correction results between Marfan syndrome scoliosis and adolescent idiopathic scoliosis-a retrospective case-series study. J Orthop Surg Res, 2015, 10:73.
[13] Levy BJ, Schulz JF, Fornari ED, et al. Complications associated with surgical repair of syndromic scoliosis. Scoliosis,2015, 10:14.
[14] Qiao J, Xu L, Liu Z, et al. Surgical treatment of scoliosis in Marfan syndrome:outcomes and complications. Eur Spine J,2016,25(10):3288-3293.
[15] Dietz HC, Cutting GR, Pyeritz RE, et al. Marfan syndrome caused by a recurrent de novo missense mutation in the fi-brillin gene. Nature, 1991, 352(6333):337-339.
[16] Zhao F, Pan X, Zhao K, et al. Two novel mutations of fibrillin-1 gene correlate with different phenotypes of Marfan syndrome in Chinese families. Mol Vis, 2013, 19:751-758.
[17] Hall JR, Pyeritz RE, Dudgeon DL, et al. Pneumothorax in the Marfan syndrome:prevalence and therapy. Ann Thorac Surg,1984, 37(6):500-504.
[18] Wood JR, Bellamy D, Child AH, et al. Pulmonary disease in patients with Marfan syndrome. Thorax, 1984, 39(10):780-784.
[19]刘广源,沈建雄,邱贵兴.马凡综合征合并脊柱侧弯术后自发性气胸一例报告.脊柱外科杂志,2004, 2(5):310-313.
[20] Kim YJ, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion:minimum 5-year follow-up. Spine, 2005, 30(18):2045-2050.
[21] Kim HJ, Bridwell KH, Lenke LG, et al. Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections. Spine, 2014, 39(9):E576-E580.
[22] Lowe TG, Lenke L, Betz R, et al. Distal junctional kyphosis of adolescent idiopathic thoracic scoliosis following anterior or posterior instrumented fusion:incidence, risk factors, and prevention. Spine, 2006, 31(3):299-302.
[23]邱勇,夏才伟,王斌,等.青少年特发性胸椎侧凸选择性融合术后的远端交界性后凸.中华骨科杂志,2009, 29(2):117-122.
[24] Sponseller PD, Ahn NU, Ahn UM, et al. Osseous anatomy of the lumbosacral spine in Marfan syndrome. Spine, 2000, 25(21):2797-2802.
[25] Jun Qiao, Feng Zhu, Leilei Xu, et al. Accuracy of pedicle screw placement in patients with Marfan syndrome. BMC Musculoskelet Disord, 2017, 18(1):123.