本文選題：脊柱側(cè)凸　切入點(diǎn)：并發(fā)癥　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的分析后路矯形手術(shù)治療脊柱側(cè)凸的并發(fā)癥發(fā)生率,探討不同病因?qū)W、年齡、性別、BMI、側(cè)凸角度等因素與術(shù)后并發(fā)癥有無(wú)關(guān)聯(lián)。方法我們對(duì)鄭州大學(xué)第一附屬醫(yī)院骨外科2010年1月至2016年2月手術(shù)治療的199例脊柱側(cè)凸的患者資料進(jìn)行回顧性分析。所有患者均行后路脊柱內(nèi)固定矯形術(shù),男性71例,女性128例,手術(shù)時(shí)平均年齡15.4歲(10歲~43歲),CS患者61例,AIS 138例。按不同年齡、不同性別、不同的病因?qū)W分類、不同Cobb角度(主彎)、不同BMI進(jìn)行分組,分別統(tǒng)計(jì)分析各種類型并發(fā)癥的發(fā)生率。使用脊柱側(cè)凸研究協(xié)會(huì)(SRS)SRS-22評(píng)分評(píng)價(jià)患者術(shù)前、術(shù)后的健康相關(guān)生存質(zhì)量(HRQL),記錄手術(shù)時(shí)間、出血量。應(yīng)用Cobb角法測(cè)定術(shù)前和末次隨訪時(shí)的側(cè)凸角度。結(jié)果患者平均隨訪4年(1.5年~5.5年),手術(shù)平均時(shí)長(zhǎng)258min,平均出血量1028ml術(shù)前平均Cobb角度為65.78°±28.37°,術(shù)后末次隨訪平均Cobb角度為24.35°±7.58°,矯正率為62.98%。術(shù)前患者SRS-22評(píng)分平均為63.78±14.86,末次隨訪為82.63±6.86。總共發(fā)生并發(fā)癥發(fā)生26例,并發(fā)癥發(fā)生率為13.06%,切口術(shù)后滲液13例,發(fā)生率為6.53%;術(shù)后感染3例,發(fā)病率1.5%;神經(jīng)并發(fā)癥4例,發(fā)生率2.01%;腦脊液漏1例,發(fā)生率0.5%;有5例患者行翻修手術(shù),發(fā)生率2.51%。CS組患者神經(jīng)并發(fā)癥發(fā)生率為6.56%,高于AIS組的0(P0.05),兩者有統(tǒng)計(jì)學(xué)差異,先天性脊柱側(cè)凸(CS)總體并發(fā)癥發(fā)生率為21.31%,高于特發(fā)性脊柱側(cè)凸(AIS)的9.42%,兩者差異有統(tǒng)計(jì)學(xué)意義,本組其他并發(fā)癥發(fā)病率無(wú)統(tǒng)計(jì)學(xué)差異。BMI18.5組的患者,切口滲液發(fā)生率為9.65%,高于BMI≥18.5的患者2.35%(P0.05),兩者有統(tǒng)計(jì)學(xué)差異,本組其他并發(fā)癥發(fā)病率無(wú)統(tǒng)計(jì)學(xué)差異。Cobb角(主彎)≥90°組患者的神經(jīng)并發(fā)癥發(fā)生率為7.01%,高于Cobb角90°(主彎)組的0(P0.05),兩者有統(tǒng)計(jì)學(xué)差異,其他并發(fā)癥發(fā)生率無(wú)統(tǒng)計(jì)學(xué)差異。不同性別及年齡的患者所有并發(fā)癥發(fā)生率均無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)論經(jīng)后路手術(shù)治療脊柱側(cè)凸效果較好,并有較高的患者滿意度。CS術(shù)后神經(jīng)并發(fā)癥發(fā)生率高于AIS組,CS組總的并發(fā)癥發(fā)生率高于AIS組;Cobb角(主彎)≥90°組患者神經(jīng)并發(fā)癥發(fā)生率高于Cobb角(主彎)小于90°組患者,BMI18.5組的患者切口滲液發(fā)生率高于BMI≥18.5組的患者。在沒(méi)有電生理監(jiān)測(cè)條件下行脊柱矯形手術(shù)時(shí),對(duì)于CS和主彎Cobb角大于90°以上的患者,醫(yī)生應(yīng)更加小心,謹(jǐn)防出現(xiàn)神經(jīng)并發(fā)癥;對(duì)于CS患者應(yīng)在手術(shù)期間與術(shù)后都應(yīng)更加關(guān)注;對(duì)于營(yíng)養(yǎng)不良患者(BMI18.5),術(shù)中應(yīng)加強(qiáng)切口縫合密度,使用可吸收線縫合切口,術(shù)后應(yīng)關(guān)注患者血白蛋白和總蛋白指標(biāo),加強(qiáng)患者營(yíng)養(yǎng)支持治療,防止切口滲液發(fā)生,預(yù)防感染。
[Abstract]:Objective to analyze the incidence of complications of posterior orthopaedic surgery for scoliosis, and to explore the different etiology and age of scoliosis. Methods the data of 199 patients with scoliosis treated by surgery from January 2010 to February 2016 in the first affiliated Hospital of Zhengzhou University were retrospectively analyzed. All patients underwent posterior spinal internal fixation orthopedics, There were 71 males and 128 females. The mean age at the time of operation was 15.4 years old or 10 years old or 43 years old with CS. According to different age, sex, different etiology classification, different Cobb angle (main curvature, different BMI) were divided into two groups. The incidence of various types of complications was statistically analyzed. The SRSS-22 score was used to evaluate the preoperative and postoperative health-related quality of life (HQL) and to record the time of operation. Bleeding volume. The angle of scoliosis was measured by Cobb angle method. Results the mean follow-up time was 4 years (1.5 ~ 5.5 years), the average operative time was 258 minutes, the mean preoperative Cobb angle was 1028ml, and the last follow-up was 65.78 擄鹵28.37 擄. The Cobb angle was 24.35 擄鹵7.58 擄and the correction rate was 62.98. The average SRS-22 score of the patients before operation was 63.78 鹵14.86, and the last follow-up was 82.63 鹵6.86.The complications occurred in 26 cases. The incidence of complications was 13.06%, 13 cases were exudate after incision, the incidence rate was 6.53; there were 3 cases of postoperative infection and 1.5 cases of morbidity; 4 cases of neurological complications, the incidence rate of 2.01%; 1 case of cerebrospinal fluid leakage (0.5%); 5 cases of revision operation; The incidence of neurologic complications in CS group was 6.56, which was higher than that in AIS group (P 0.05). There was statistical difference between the two groups. The overall complication rate of CSS in congenital scoliosis was 21.31%, which was higher than 9.42% in idiopathic scoliosis group (AIS), and the difference was statistically significant. There was no statistical difference in the incidence of other complications. The incidence of incision exudation was 9.65 in the group of BMI18.5, which was higher than that in the group with BMI 鈮，

本文編號(hào)：1608560