脊柱侧凸矫形术后并发肠系膜上动脉综合征

目的探讨在脊柱侧凸矫形术后并发肠系膜上动脉综合征的发病机制,分析总结该并发症在脊柱侧凸矫形术中的易发因素。方法回顾性研究1997年7月～2001年1月,采用三维去旋转矫形技术矫治各种脊柱侧凸430例,共发生肠系膜上动脉综合征5例,3例发生在脊柱侧凸前路松解术后颅骨-骨盆牵引过程中,2例发生在后路矫形术后。结果5例患者经禁食、胃肠减压、维持水电解质平衡、左侧卧位、暂停或减轻颅骨-骨盆牵引重量后症状逐渐缓解,5～7d后均痊愈。结论严重的脊柱侧凸,特别是后突型,术前躯干塌陷明显,估计术中脊柱伸展多、纠正百分比高或前路术后需快速大重量牵引的患者易并发肠系膜上动脉综合征。对此症只要早期诊断和及时处理,预后较好。

Superior mosenteric artery syndrome after surgery of scoliosis

Objective To explore the pathogenesis of the superior mesenteric artery syndrome (SMAS) after surgical correction of scoliosis, and to analyse the inducing factors of the SMAS during scoliosis correction. Methods From July 1997 to January 2001, 430 cases of scoliosis were corrected with the 3 dimensional derotation technique(312 cases of the CD instrumentation and 118 cases of the TSRH or CDH instrumentation), 5 cases of which suffered from the SMAS postoperatively. Three of these 5 cases had the SMAS during the heavy Halo-pelvic traction following the anterior spinal release, the other two cases happened after the posterior correction. Results For the 5 patients, the symptoms were relieved after fasting,drainage with nasogastric tube, keeping electrolytic balance, left lateral position, suspense or reduction of the heavy traction, all of them recovered completely after 5-7 days. Conclusion SMAS is apt to occur in severe scoliosis, especially in kyphoscoliosis with trunk collapse. If more spine elongation and higher correction rate are obtained during operation, or the heavy Halo-pelvic traction is necessary after the anterior spinal release, the SMAS is more likely to happen. Early diagnosis and treatment play an important role in the recovery of patients.