腰椎间盘切除术椎前血管损伤并发症的文献分析  

Anterior vertebral vascular complications associated with surgical excision of the prolapsed lumbar disc

作　　者：闫韵飞[1] 赵建宁[1] 许斌[1] 

机构地区：[1]南京军区南京总医院骨科,南京医学硕士研究生210002

出　　处：《医学研究生学报》2013年第6期610-614,共5页Journal of Medical Postgraduates

摘　　要：目的后路椎间盘切除术是当前脊柱外科最常见的手术之一,而椎前腹部血管损伤(动静脉撕裂、动静脉瘘、假性动脉瘤等)是腰椎间盘切除术的严重并发症,此种并发症有多种治疗方法。文中回顾后路腰椎间盘切除术椎前血管并发症的相关文献,总结其治疗方法,为临床治疗提供参考。方法在PUBMED数据库中检索2000年1月至2011年3月所有后路腰椎间盘切除术椎前血管损伤并发症的英文文献,结合临床1例分析该并发症的发生原因及相关解剖因素。结果检索到相关文献26篇,共报告23例患者出现椎前血管损伤,损伤类型包括血管撕裂、动静脉瘘、假性动脉瘤。血管撕裂主要通过手术修复损伤的血管,修复方式包括缝补、结扎、断端吻合等,而动静脉瘘及假性动脉瘤则主要通过腔内血管移植治疗。结论腰椎间盘手术椎前血管损伤属医源性损伤,虽然发生率不高,应引起高度重视。当出现血循环显著改变、腹部异常及剧烈疼痛等症状时,应考虑到血管损伤的可能,及时处置。ObjectivePosterior discectomy is a most common procedure in spinal surgery, while anterior vertebral vascular injury, including arteriovenous tear, arteriovenous fistula, and pseudoaneurysm, is a serious complication of lumbar discectomy, for which there are various methods of treatment. The authors reviewed the literature relating early and late vascular complications of lumbar disc surgery and summarized their treatment methods.MethodsWe searched the PubMed database for all relevant English literature on the vascular complications associated with surgical excision of the prolapsed lumbar disc via the posterior approach reported between Jan 2000 and Mar 2011. With a report of 1 case in our department, we analyzed the causes and anatomical factors of this complication.ResultsTotally 26 studies were identified, which reported 23 cases of anterior vertebral vascular injury, including vascular tear, arteriovenous fistula, and pseudoaneurysm. Vascular tear was treated mainly by suturing, ligation or anastomosis of the injured vessels, while arteriovenous fistula and pseudoaneurysm chiefly by vessel grafting within the arterial lumen.ConclusionAnterior vertebral vascular injury during lumbar disc surgery, although rare, should receive serious attention, and immediate intervention is required in case of such symptoms as circulatory instability, abdominal abnormality and severe pain after surgery.

关 键 词：血管损伤 血管并发症 腰椎间盘手术 椎间盘突出 

分 类 号：R681.53[医药卫生—骨科学]