颈椎前路手术围手术期并发症原因分析与防治  

PERIOPERATIVE COMPLICATIONS IN ANTERIOR CERVICAL SPINE SURGERY:CAUSES,PRENVENTION AND CURE

作　　者：郑炳鑫 陈晓亮[1] 马进峰[1] 周传利[1] 

机构地区：[1]青岛大学医学院附属医院脊柱外科,山东青岛266003

出　　处：《青岛大学医学院学报》2015年第2期212-214,216,共4页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的探讨颈椎前路手术围手术期并发症的发生原因及防治策略。方法回顾性分析涉及颈椎前路手术病人1 421例临床资料,其中一期前路手术1 372例,二期前路手术4例,一期前后路联合手术45例;颈椎病1 117例,颈椎外伤253例,颈椎肿瘤41例,颈椎感染10例。手术操作方式有椎间盘切除、椎体次全切除、病灶清除、肿瘤切除;植骨方式有自体髂骨、Cage或钛网+自体骨或同种异体骨等。除13例外其余病人均采用前路带锁钛板固定。结果共91例(113例次)发生围手术期并发症,发生率为7.95%。其中脑脊液漏29例次,呼吸道症状28例次,咽喉部症状19例次,颈部血肿10例次,神经症状加重8例次,取髂骨相关并发症6例次,血管血栓4例次,电解质紊乱4例次,切口感染、血肿2例次,内固定相关2例次,血管损伤1例次。结论颈椎前路围手术期可发生多种并发症,熟悉颈椎前路临床解剖、提高手术技巧、加强围手术期处理并制定个体化诊治方案可减少其发生。Objective To analyze perioperative complications of anterior cervical surgery （ACS） and its prevention and treatment. Methods A retrospective review was conducted in clinical data of 1 421 patients underwent ACS, of which, one- stage ACS was done in 1 372 cases, two-stage in four, and one-stage combined anterior and posterior cervical spine surgery in 45 cases. The surgery was performed for cervical spondylosis in 1 117 cases, cervical injury in 253, cervical tumor in 41 cases, and cer- vical infection in 10. The operative procedures included disectomy, subtotal corpectomy, debridement and tumor resection, bone grafting included autogenic iliac bone autograft, peek cage/titanium mesh cage with autogenic or allogeneie bone. Anterior cervical spine locking plates were used in all except 13 cases. Results Perioperative complications occurred in 91 patients （113 cases/ time）, with an incidence of 7.95o//00. In which, leakage of cerebrospinal fluid in 29 cases/time, respiratory symptoms in 28 cases/ time, laryngeal and pharyngeal sympotom in 19 cases/time, the neck hematoma in 10 cases/time, deterioration of neurological function in eight cases/time, iliac-taken-related complications in six cases/time, vascular thrombosis in four cases/time, electrolyte imbalance in four cases/time, internal-fixation-related complications in two cases/time, and injury of blood vessel in one case/time. Conelusion Many kinds of perioperative complications may happen in anteror cervical surgery. Having an intimate knowledge of clinical anatomy of anterial cervical spine, improving operative skills, enhancing perioperative management and formulating proto- col for indivi-dualized diagnosis and therapy may decrease the complications.

关 键 词：颈椎 减压术 外科 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]