颈椎前路手术患者围手术期死亡相关因素分析

目的探讨颈椎前路手术患者围手术期死亡的相关因素。方法颈椎前路手术412例,其中颈椎病258例,颈椎外伤138例,颈椎肿瘤8例,颈椎结核8例。选取性别、年龄、术式等指标进行统计分析。结果围手术期内8例患者死亡,统计分析显示病例死亡同并发症、瘫痪情况和病种三因素相关。结论颈椎前路手术患者围手术期死亡主要同患者自身病情有关,加强围手术期管理可能会降低病死率。     

颈椎前路手术早期并发症相关因素分析

目的：探讨颈椎前路手术早期并发症的相关因素。方法：回顾1992年1月～2003年12月行颈椎前路手术治疗的412例患者的早期并发症情况，其中颈椎病258例，颈椎外伤138例，颈椎肿瘤8例，颈椎结核8例，选取性别、年龄、术式等指标进行统计，对其进行单因素筛选、多因素Logistic回归分析。结果：共42例出现51例次早期并发症，发生率为10．19％，与手术直接相关的并发症28例次(6．80％)，间接并发症23例次(5．08％)；颈椎外伤患者并发症发生率较颈椎病患者高：单因素分析显示与颈椎前路手术早期并发症相关的主要因素有病种、瘫痪情况、术式．多因素Logistic回归分析显示病种是决定术后早期并发症发生的主要凶素。结论：颈椎前路手术早期并发症的发生主要与病种、病情有关，病情越复杂，发生并发症的可能性越大：颈椎外伤患者早期并发症的发生率较颈椎病患者为高。     

颈椎前路手术的早期并发症及其预防和处理

[目的]分析颈椎前路手术早期的各种并发症,探讨相关的影响因素及应对策略.[方法]回顾分析本院1997年1月～2011年3月559例经颈椎前路手术的各种早期并发症发生情况,对患者的病种、性别、年龄、全身并发症情况、手术、麻醉、护理及瘫痪情况多因素进行分析,分析相关并发症的可能发生原因,介绍处理方法.[结果]118例患者141例次出现术后早期并发症,发生率25.22％,其中,术后吞咽困难53例,喉上神经或喉返神经损伤11例,颈部切口血肿4例,脊髓损害加重3例,食道瘘1例,脑脊液漏4例,取骨区血肿或脂肪液化感染5例,低钠血症39例,肺部感染12例,下肢深静脉血栓形成5例,死亡4例.[结论]充分的术前准备与评估,熟悉的颈椎前路手术解剖知识及认真仔细的操作,术后仔细的观察及护理是预防颈椎前路手术早期并发症的关键.     

颈椎前路手术早期并发症危险因素分析

目的探讨颈椎前路手术早期并发症危险因素,为防治颈椎前路手术早期并发症提供科学依据。方法回顾性分析自2010-01—2014-12新疆医科大学第六附属医院诊治的103例颈椎前路手术,采用单因素分析性别、年龄、民族、病程、瘫痪情况、术前合并症、手术方法、手术节段、麻醉方式、手术时间、出血量、病种等指标,采用Logistic回归分析对发生颈椎前路手术早期并发症的危险因素进行分析。结果本组103例术后随访3~24个月,平均16个月。103例中发生并发症12例,发生率为11.65%。单因素分析发现,病种(χ2=28.540,P0.001)、瘫痪情况(χ2=19.529,P0.001)、术前合并症(χ2=11.936,P=0.001)、手术方法 (χ2=12.718,P=0.005)与术后早期并发症的发生有关。对病种、瘫痪情况、术前合并症、手术方法 4个因素进行多因素Logistic回归分析,结果显示患者的瘫痪情况和手术方法是影响颈椎前路手术早期并发症发生的独立危险因素(P0.05)。结论颈椎前路手术时应严格把握手术适应证,根据患者个体情况选择适当的手术方式,从而避免或减少患者术后并发症的发生。     

围手术期综合救治对颈前路手术并发症的影响

颈椎伤病致颈髓损伤是极具破坏性损伤，常常危及生命。颈前路减压植骨内固定是治疗颈椎伤病重要而有效的手术方法。围手术期综合救治对颈前路手术良好实施、促进颈髓神经功能恢复、有效防止各种并发症发生具有重要作用。现将自2004年3月-2006年1月开展的16例颈前路手术围手术期综合救治情况作如下分析。     

颈椎前路手术早期并发症原因分析及对策

目的总结颈椎前路手术的术中、术后早期并发症,分析原因并提出对策。方法回顾1992年1月至2003年12月颈椎前路手术412例,男308例,女104例;年龄18～76岁,平均45.6±12.9岁。颈椎病258例,颈椎外伤138例,颈椎肿瘤8例,颈椎结核8例。412例患者,病史最短4小时,最长达20年,平均548d。全瘫58例(14.1%),不全瘫192例(46.6%),无瘫痪症状162例(39.3%)。麻醉包括三大类(5种)局麻(局部浸润35例、颈丛阻滞52例、局部浸润 颈丛阻滞6例、全麻318例、全麻 颈丛1例。前路减压、自体髂骨植骨融合33例,前路减压、椎间融合器椎间融合术32例,前路减压、自体髂骨植骨融合、前路钢板内固定术347例。结果共42例51例次出现早期并发症,并发症的例次发生率为12.37%。28例次(6.80%)同手术直接相关,喉上神经损伤5例次,喉返神经损伤4例次,颈部切口感染及血肿4例次,脊髓损害症状加重5例次,神经根损伤2例次,植骨块移位2例次,取骨区感染及血肿各1例次,钢板、螺钉松动2例次,螺钉位置不当1例次,食管瘘1例次;23例次(5.08%)同手术间接相关。结论降低颈椎前路手术并发症的发生率,不仅要熟悉颈椎前路临床解剖,提高手术技巧,还要做好颈椎前路手术围手术期的处理。     

术前类固醇应用史对选择性前路腰椎融合术围手术期并发症的影响

目的 探讨术前类固醇应用史对选择性前路腰椎融合术(anterior lumbar fusion,ALF)围手术期并发症的影响.方法 选择2015年1月～2020年1月在本院行ALF、术前类固醇应用史的112例患者资料作为研究组,抽取同期在本院行ALF、无术前类固醇应用史的患者112例作为对照组.对两组患者的围手术期并发症发生情况进行比较;以是否发生围手术期并发症为应变量,采用多因素分析以验证术前类固醇应用史对围手术期并发症发生率的影响.结果 研究组围手术期总并发症发生率高于对照组,差异有统计学意义(P<0.05).多因素分析显示,术前类固醇应用史是围手术期并发症的风险因素(P<0.05),其他风险因素包括:年龄≥60岁、ASA分级Ⅲ～Ⅳ级、≥3个节段融合、翻修手术(P<0.05).结论 术前类固醇应用史与ALF手术患者围手术期并发症增加相关.     

颈椎前路手术后出现早期并发症的相关因素分析

目的探讨颈椎前路手术后出现早期并发症的相关因素,以期为临床提供参考价值。方法回顾分析2009-05-2014-07开展的颈椎前路手术110例,其中颈椎骨折、脱位34例,颈椎病44例,颈椎结核17例,颈椎肿瘤15例;采用前路减压植骨融合术37例,前路减压植骨融合+AO钢板内固定25例,前路减压植骨融合+Orion钢板内固定29例,前路减压植骨融合+蝶形钢板内固定19例。手术范围:单节段手术61例,2节段27例,3节段15例,4节段7例。并依据早期并发症发生与否,统计患者的性别、年龄,疾病类型、病程,术前瘫痪情况,合并症,麻醉方式,手术方式,手术节段,手术时间,术中出血量等信息,作为自变量;以患者术后是否出现早期并发症作为因变量,进行单因素和多因素Logistic回归分析。结果单因素分析发现,疾病类型(x~2=10.782,P=0.013)、瘫痪情况(x~2=15.789,P0.01)以及术前有无合并症(x~2=40.205,P0.01)、手术方法(x~2=9.819,P=0.02)这4项指标的组间差异有统计学意义(P0.05),提示这4项指标与颈椎前路手术后早期并发症的发生有关。多因素Logistic回归分析发现,患者的手术方式(β=1.712,S.E.=0.563,P=0.005)与疾病类型(β=1.725,S.E.=0.758,P=0.026)是影响颈椎前路术后早期并发症的独立危险因素。结论颈椎前路手术后出现早期并发症,主要与手术方式和疾病类型有关,行单纯减压植骨融合术的早期并发症发生率偏高,颈椎外伤与肿瘤、结核患者术后可能更易发生早期并发症。     

颈椎前路围手术期护理

目的对临床接受颈椎前路手术的患者在整个围手术期的护理措施进行分析,并总结相关护理体会。方法抽取22例笔者所在医院就诊的患有颈椎疾病的临床确诊患者病例,对其实施颈椎前路手术治疗,对患者在围手术期内的护理措施和相关护理体会进行总结。结果术前对患者进行常规准备、心理护理、气管食管推移训练、体位训练、佩戴颈托等护理;术后对患者进行常规监测、体位护理、饮食护理、切口护理、康复锻炼等护理,所有患者的手术均顺利完成,并均在预计的时间内康复出院。结论对接受颈椎前路手术的颈椎病患者在患者的围手术期为其提供有针对性的护理服务,可以有效保证患者的手术顺利完成,确保手术达到预期的治疗效果,促进患者迅速恢复,在今后的临床护理工作中应该给予充分的重视。     

颈椎前路手术早期并发症

目的:分析总结颈椎前路手术早期并发症的原因,探索防范策略和治疗措施.方法:总结1999年7月～2003年7月在本院接受颈椎前路手术的412例患者的临床资料.手术方式:环锯椎体次全切除减压、椎间盘切除减压、肿瘤椎体切除、病灶清除、齿状突骨折复位螺钉内固定、下颈椎骨折脱位复位内固定;植骨方式:大块自体髂骨植骨、髂骨块椎间植骨、PEEK Cage椎间融合器髂骨植骨融合、钛网髂骨植骨融合;多数患者采用前路钛板固定.术后328例出现早期并发症.结果:276例出现术后咽喉部刺激症状,是最多见的并发症,预后好;62例出现低钠血症,常发生在一般情况较差的老年患者和严重颈椎创伤的患者,病情顽固,纠正困难;10例脑脊液漏;8例喉返神经损伤皆为一过性,术中可以即刻出现,是最早出现的并发症;4例死亡,瘫痪加重7例,此二者是最严重的并发症;5例刀口内血肿;2例髂骨取骨处刀口脂肪液化;2例刀口感染;1例食道瘘.植入物并发症2例,钛板螺钉打入椎间隙.3例行早期翻修手术.结论:颈椎前路手术并发症较多,咽喉部刺激症状被忽视,此种并发症相当多见,但痊愈快,预后好.多数并发症可以治愈,部分可导致严重后果甚至死亡,围手术期严格管理和手术规范化是减少并发症的关键.     

Risk factors for perioperative cardiac complications after lumbar fusion surgery

Cardiac complication is a leading cause of death in the perioperative period after non-cardiac surgery. The present study retrospectively investigated perioperative cardiac complications after spinal fusion surgery in 901 consecutive adult patients who underwent fusion surgery in the lumbar spine from January 2005 to December 2006. Cardiac complications developed in seven patients (0.8%), four males and three females aged 62 to 75 years (mean 66.6 years), in the perioperative period (myocardial infarction in 6 and angina pectoris in 1). Cardiac complications developed after mini-open transforaminal lumbar interbody fusion in four patients and after anterior lumbar interbody fusion in three. No patient had any symptoms related to cardiac disease before surgery. Common features were age over 60 years, a medical history of hypertension and/or diabetes mellitus, and presence of calcified atherosclerosis of the abdominal aorta and/or common iliac arteries. Five patients improved after conservative medical treatment in an intensive care unit. Percutaneous transluminal coronary angioplasty was performed in one patient and coronary artery bypass graft surgery in one. The possibility of perioperative cardiac complications should be considered before lumbar fusion surgery, especially in elderly patients with hypertension and/or diabetes mellitus, and calcified atherosclerosis of the abdominal aorta and/or common iliac arteries.     

颈椎前路内固定术后中远期食管并发症

 目的 探讨颈椎前路内固定术后中远期食管并发症的发生率及其诊疗策略。方法 对2001年1月至2011年12月2316例行颈椎前路内固定手术患者发生的中远期食管并发症情况进行回顾性分析。食管中远期并发症包括术后2周以上发生的食管穿孔、食管气管瘘、食管皮下瘘、食管憩室、食管胸膜瘘及食管狭窄等。结果 共4例患者发生中远期食管并发症,发生率为0.17%(４/２３1６),其中食管穿孔发生率为0.09%(2例)。病例1为31岁男性患者,自体髂骨移植融合加钢板内固定(C5)术后7年发现食管憩室合并食管穿孔。手术取出内固定,清创后切除憩室,胸骨舌骨肌及肩胛舌骨肌肌瓣修补食管。病例2为46岁男性患者,自体髂骨移植融合加钢板内固定(C5)术后3年发现食管憩室。手术取出内固定,切除食管憩室,胸骨舌骨肌及肩胛舌骨肌肌瓣修补食管。病例3为58岁女性患者,自体髂骨移植融合加钢板内固定(C6)术后5年出现食管憩室。手术取出内固定,切除食管憩室,胸锁乳突肌肌瓣修补食管。病例4为56岁女性患者,钛网植骨融合加钢板内固定(C6)术后3年出现食管穿孔。手术取出内固定,清创后胸锁乳突肌肌瓣修补食管。4例患者术后食管并发症均获得成功治疗,恢复良好。结论 颈椎前路内固定术后中远期食管并发症的发生率较低,X线片、消化道造影及消化道内镜检查是主要的诊断方法,手术是其主要的治疗手段。     

手术治疗强直性脊柱炎合并颈椎骨折脱位的临床研究

目的探讨强直性脊柱炎（AS）合并外伤性颈椎骨折脱位的病理特点,评价前后路联合手术疗效。方法回顾性分析2000年1月至2006年1月治疗的18例AS合并外伤性颈椎骨折脱位患者。AS平均病程14．5年,3例既往行腰椎截骨矫形手术。术前Frankel分级：A级4例,B级3例,C级9例,D级2例。均为前后路联合手术。结果应用前-后入路4例,前-后-前入路8例,后-前入路6例。一期手术7例,分期11例。术后神经功能除4例A级随访无改善外,其余14例均有不同程度恢复。平均随访21．2个月,术后平均3．6个月植骨获得融合,无内固定失败。围手术期并发症4例,远期1例。结论本研究提示前后路联合手术能取得即刻脊柱三维稳定,有效解除脊髓前后方压迫,是累及三柱的AS合并颈椎骨折脱位的合理外科治疗方式。     

Early dysphagia complicating anterior cervical spine surgery: incidence and risk factors

Background

Dysphagia is a common complication of anterior cervical spine surgery, and most of them occurred in the early postoperative period. This study aimed to determine the incidence of early dysphagia after anterior cervical spine surgery and to identify its risk factors.

Methods

A review of 186 consecutive patients undergoing anterior cervical spine surgeries in a 3-year period was performed. Dysphagia at postoperative 1 month was surveyed, and the severity of dysphagia was evaluated. Demographic information and procedural characters were collected to determine their relationships to dysphagia.

Results

A total of 50 patients developed early postoperative dysphagia, including 23 males and 27 females. The incidence of early dysphagia after anterior cervical spine surgery was 26.9 % in this study. Mild, moderate, and severe dysphagia were found in 30, 14, and 6 patients, respectively. Female, advanced age, multi-levels surgery, use of plate, and a big protrusion of plate were found to be significantly increased early dysphagia after anterior cervical spine surgery.

Conclusion

There is a relatively high incidence of early dysphagia after anterior cervical spine surgery, which may be attributable to multiple factors.     

Oesophageal perforation after anterior cervical surgery: management in four patients

Background  Oesophageal perforation related to anterior cervical surgery is an uncommon but well recognised and potentially life-threatening complication with an incidence of 0–3.4%. Our experience with this complication and a review of the literature are presented. Method  We retrospectively reviewed our clinical experience over 10 years and found four patients in whom an oesophageal perforation was recognised after anterior surgery for cervical spine trauma. In three patients the perforation was noticed in the early post-operative period and the other had a delayed presentation. In all patients, the hardware was removed, long-term intravenous antibiotics were administered and parenteral nutrition was instituted. In two patients a primary suture of the perforation was performed and in one of these an additional sternocleidomastoid myoplasty was carried out as well. One patient had conservative treatment and one died before closure of the perforation could be performed. Findings  The two patients, in whom surgical repair of the perforation was performed, recovered well with residual neurological deficits as expected due to the cervical trauma. In the patient in whom conservative treatment was instituted, healing of the perforation occurred. One patient died due to systemic complications, indirectly related to the perforation. Conclusions  Although not very frequent and sometimes difficult to diagnose, oesophageal perforations after anterior cervical surgery constitute a potentially life-threatening complication. Diagnosis is made by imaging or endoscopic studies, but clinical suspicion is most important. Basic treatment consists of surgery with removal of hardware, drainage of abscesses, primary closure of the perforation if possible, parenteral nutrition and antibiotic therapy. Residual instability should be recognised in time and may be anticipated in patients in whom there has been little time for solid bony fusion. Successful management depends on early diagnosis and immediate institution of treatment.     

Perioperative neurologic complications during spinal fusion surgery: incidence and trends

Background Context

Perioperative neurologic complications after spine surgery may increase morbidity and health-care costs related to the procedure.

前路钢板结合钛网植骨在不稳定型下颈椎骨折治疗中的应用

目的观察钛网结合钛钢板内固定治疗不稳定型下颈椎骨折的临床效果。方法对36例不稳定型下颈椎骨折患者应用前路减压、钛网植骨加前路钢板固定,并对其疗效进行评价。结果所有患者随访4~28个月,平均随访17个月,按Frankel评分标准进行术前术后神经功能评定;围手术期无明显并发症,植骨均在术后12周达到临床愈合,颈椎生理曲度保持良好,无椎间盘高度的丢失,钛网无下沉、移位,钢板及螺钉无松动,无神经、血管并发症。术后3.5个月开始出现融合迹象,术后1年骨融合良好。结论不稳定型下颈椎骨折应用前路颈椎钢板固定技术结合钛网植骨治疗,颈椎生理曲度得到恢复,术后颈椎即时稳定性好,并能维持有效的椎间高度,植骨易于融合。通过自体椎体开槽减压取骨或加异体骨植骨避免了髂骨取骨所带来的损伤及手术时间的延长,且住院时间短,有利于患者的早期下床活动和功能恢复。手术病例及方法的选择应根据患者是否有致压因素及颈椎稳定性等情况综合考虑。     

脊髓型颈椎病前路手术并发症的临床分析

目的分析脊髓型颈椎病前路手术的并发症及其原因，寻找防治对策。方法对96例脊髓型颈椎病患者采用前路减压植骨融合术，其中前路减压自体髂骨植骨融合16例，前路减压TFC椎间融合24例，前路减压自体髂骨植骨融合、前路锁定钢板固定56例。观察并分析术后并发症的发生情况。结果96例均获得随访，时间36—84（66±14）个月。发生并发症40例（51例次），发生率为41．7％。术后早期并发症包括：喉上神经损伤2例，硬膜破裂1例，植骨块移位1例，谵妄9例，C5神经麻痹6例，经过相应的对症处理均获得痊愈。远期并发症主要为邻近节段退变32例。4例出现新的神经症状和体征，其中2例再次行前路手术，术后症状有明显改善。结论颈椎前路手术伴有较高的并发症发生率，其原因是多方面的，均不同程度地影响着手术效果．尤其是邻近节段退变,临床应重视。