颈椎前路减压术合并椎动脉损伤  

Vertebral artery injury during anterior decompression of the cervical spine

作　　者：任先军[1] Caspar W Fuchs GA 

机构地区：[1]第三军医大学新桥医院骨科,重庆400037 [2]德国萨尔大学神经外科 [3]德国拜罗伊特医学中心骨科

出　　处：《中华骨科杂志》2000年第8期461-463,共3页Chinese Journal of Orthopaedics

摘　　要：目的 探讨颈椎前路减压术中椎动脉损伤的危险因素及其处理方法。方法 1980年 1月～ 1998年 12月，对 720例患者行颈椎前路减压术，减压范围包括 1～ 3个椎间隙并行椎体次全切除。术中采用高速磨钻切除骨及椎间盘组织。 630例患者同时行颈椎前路 Caspar钢板内固定术。 3例行椎间减压时向侧方切除过多，导致椎动脉损伤，采用明胶海绵加游离肌片局部填塞止血。结果 720例中椎动脉损伤发生率为 0.4％， 3例均压迫止血成功，无一例出现脑缺血等神经系统症状。结论 颈椎前路减压时不应跨越钩椎关节，局部明胶海绵加游离肌片填塞是有效的椎动脉止血方法。Objective To evaluate the risk factor and treatment method of the vertebral artery injury during anterior decompression of the cervical spine. Methods Seven hundred and twenty patients undergone anterior cervical operation from January 1980 to December 1998 were reviewed. The range of decompression included one level, two levels, three levels and subtotal vertebral body resection. Speed burr was used to resect the bone and disc. Caspar plate was implanted in 630 cases after decompression. Three cases suffered iatrogenic vertebral artery injury when removal of bone and disc was excessive laterally. Emergent control of haemorrhage was achieved by local tamponade using hemostatic agent and free muscle slice. Results Vertebral artery injury occurred in 0.4％ of this series. The control of haemorrhage had been successful by tamponade in all of the three cases. None had ischemic complications. Conclusion Decompress laterally from the uncovertebral joint should not be attempted. Local tamponade using hemostatic agent and free muscle slice was effective to control vertebral artery bleeding.

关 键 词：颈椎前路减压术 并发症 椎动脉损伤 

分 类 号：R687[医药卫生—骨科学]