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目的:比较伴或不伴椎体旋转半脱位（rotatory subluxation，RS）的脊柱畸形患者矫形术中神经并发症的发生率，分析RS与术中神经损害的相关性。方法:回顾性分析2012年1月至2017年8月术前合并RS的脊柱畸形接受矫形内固定手术且术前未行牵引及术中三柱截骨手术37例患者（RS组）的病历资料，另选取37例不伴RS的脊柱畸形患者作为对照（对照组）。测量的影像学参数包括主弯侧凸Cobb角、冠状面平衡（coronal trunk balance，CTB）、最大后凸Cobb角（global kyphosis，GK）、矢状面偏移(sagittal vertical axis，SVA)、冠状位椎体半脱位距离（coronal rotatory subluxation，CRS）、矢状位椎体半脱位距离（sagittal rotatory subluxation，SRS）、RS椎体轴面旋转角度（axial rotation，AR）等。记录患者术中出现神经电生理监测不良事件及唤醒试验阳性的发生率。结果:RS组患者年龄为（42.4±17.9）岁（12~74岁），对照组患者年龄为（42.7±18.3）岁（12~74岁），差异无统计学意义（n t=0.0713，n P=0.943）。RS组术前主弯Cobb角、CTB、GK、SVA分别为75.4°±29.7°、（38.4±28.4）mm、52.8°±25.2°、（40.3±36.8）mm，对照组分别为75.1°±27.6°（n t=0.045，n P=0.964）、（34.8±24.4）mm（n t=0.584，n P=0.560）、49.8°±22.5°（n t=0.540，n P=0.591）、（38.7±25.3）mm（n t=0.219，n P=0.828），两组患者的差异均无统计学意义。RS组和对照组患者术后主弯侧凸Cobb角、CTB、GK、SVA、CRS、SRS和AR均得到明显矫正（n P值均0.05）。术前合并下肢神经功能损害，RS组6例（16.2%）、对照组4例（10.8%）（n F=0.463，n P=0.496），Frankel分级均为D级。术中神经电生理监测不良事件，RS组5例（13.5%）、对照组1例（2.7%）（n F=2.902，n P=0.088）。2例RS组患者（5.4%）术中唤醒试验阳性（n F=2.056，n P=0.493）。n 结论:伴RS的脊柱畸形患者具有较高的术前神经损害发生率，术中出现神经电生理监测不良事件及神经损害加重的风险高于对照组，术前合并RS是脊柱矫形手术中发生神经损害的可能危险因素。“,”Objective:To compare the incidence of intraoperative neurological complications during correction surgery of spinal deformities in patients with or without rotatory subluxation (RS), and to analyze the correlation between RS and intraoperative neurological complications.Methods:From January 2012 to August 2017, a total of 37 patients with RS undergoing correction surgery, whom was excluded with preoperative spinal traction or three-column osteotomy during operation were retrospectively reviewedin our hospital. Thirty-seven patients without RS undergoing correction surgery were included asthe control group. The radiographic parameters included Cobb angle of main curve, coronal trunk balance (CTB) which was the distance between Cn 7 plumb line and center sacral vertical line, global kyphosis (GK), sagittal vertical axis (SVA), RS at coronal plane (CRS), RS at sagittal plane (SRS) and axial rotation (AR). The abnormal intraoperative neurophysiological monitoring events and positive wake-up test were recorded.n Results:The mean age was 42.4±17.9 years (12-74 years) in the RS group and 42.7±18.3 years (12-74 years) in the control group(n t=0.0713, n P=0.943). The mean preoperative Cobb angle of main curve, CTB, GK, and SVA was 75.4°±29.7°, 38.4±28.4 mm, 52.8°±25.2°, and 40.3±36.8 mm respectively in the RS group, which was 75.1°±27.6°(n t=0.045, n P=0.964), 34.8±24.4 mm(n t=0.584, n P=0.560), 49.8°±22.5°(n t=0.540, n P=0.591), and 38.7±25.3 mm (n t=0.219, n P=0.828) respectively in the control group. There was no significant difference between the two groups among the above preoperative index. Significant improvements in Cobb angle of main curve, CTB, GK, SVA,CRS, SRS and ARA were found between preoperation and postoperation (n P0.05 for all). There were 6 patients (16.2%) in the RS group and 4 patients (10.8%) in the control group with preoperative neurological deficit of Frankel grade D (n F=0.463, n P=0.496). The abnormal intraoperative neurophysiological monitoring events were observed in 5 patients (13.5%) of the RS group and 1 patient (2.7%) of the control group (n F=2.902, n P=0.088). Positive wake-up test was found in 2 patients of RS group (5.4%) (n F=2.056, n P=0.493).n Conclusion:Patients with RS had higher risks of preoperative neurological deficit, abnormal intraoperative neurophysiological monitoring events and deteriorative neurological deficit at postoperation. The RS at preoperation may be a risk factor for intraoperative neurological deficit.