脊柱畸形手术后翻修：原因和手术策略

专题组织人：陈仲强教授
　　自从1911年Hibbs和Albee等首次报道脊柱融合术以来，该手术已成为脊柱外科应用最广泛的技术之一。在脊柱畸形的矫正中，利用椎弓根钉行坚强内固定和良好的植骨融合可有效矫正畸形，然而仍有部分患者因矫形效果不满意或术后畸形进一步加重需要行翻修手术。Scheer等的研究表明，脊柱畸形术后翻修率高达17%^[1]_。脊柱畸形术后翻修的主要原因有：融合节段选择不当导致术后脊柱失平衡^{[2, 3]}_:侧凸进行性加重；迟发性手术部位疼痛；植骨不融合导致假关节形成^[4]_:内固定物失败，如脱钩、断钉、断棍或螺帽松动^[5]_:内固定物位置错误；伤口深部感染；矫形不足或矫形效果丢失；迟发性神经症状等^[6]_。翻修手术的手术策略是明确初次手术失败的原因，再根据原因做出相应的处理^{[7, 8]}_。同时，为保障翻修手术的安全性，术前必须进行彻底的评估^{[9, 10]}_。具体的手术策略包括：保留原有内固定物，延长固定节段；取出原有内固定物，植入新的内固定物矫形融合；后路植骨融合椎弓根钉-棒系统内固定；后路截骨矫形；拆除内固定，彻底清创等。尽管术前进行了严密评估，术后仍有部分患者出现侧凸加重及内固定的失败，您对脊柱畸形翻修的原因有何新见解？你认为翻修术中有哪些需要注意的事项？如何尽量减少翻修手术的发生率？如何保证翻修手术的安全性？您的看法是什么？

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