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1.
颈前路手术早期并发症的防治   总被引:1,自引:0,他引:1  
目的总结分析颈椎前路手术早期并发症,探讨其防治策略。方法1998年11月-2006年12月,采用前路手术治疗颈椎疾患363例,其中男268例,女95例;年龄17~79岁,中位年龄50.6岁。颈椎病224例,颈椎间盘突出症39例,颈椎外伤87例,颈椎肿瘤9例,颈椎结核4例。采用前路减压、自体髂骨融合治疗48例,前路减压、植骨融合联合带锁钢板内固定132例,前路减压、钛网植入联合带锁钢板内固定183例。结果术后282例获随访3个月~5年,平均1年11个月。手术相关并发症23例,发生率为8.16%。喉上神经损伤3例,经禁流质饮食及补液治疗,术后3~7d症状消失;喉返神经损伤2例,行发音训练,3个月后恢复正常;脊髓损伤1例,经抗炎脱水治疗,下肢肌力6个月后恢复至术前水平;硬脊膜撕裂2例,经皮肤肌肉严密缝合,切口适度加压包扎后愈合;内固定相关并发症10例,其中1例螺钉拔出,因吞咽困难行再次手术,余行对症治疗、头颈胸石膏固定,3~18个月后固定节段融合:颈部血肿形成4例,其中1例因抢救方法不当死亡;植骨区及创口感染1例。结论充分的术前准备、熟悉颈前路解剖以及严格规范化操作,是预防颈椎前路手术早期并发症的关键。  相似文献   

2.
颈椎前路手术的并发症及其处理   总被引:4,自引:1,他引:3  
目的:探讨颈椎前路手术的并发症及其处理方法。方法:2000年5月至2006年5月共行颈椎前路手术523例,手术方式采用环锯减压 cage或植骨 带锁钢板固定278例;椎体次全切除或颈前路开槽减压 钛网植骨 带锁钢板固定245例。术后随访403例,随防内容包括症状及体征的改善情况,并每月进行一次颈椎X线检查。结果:随访6个月至6年,平均2年10个月,81例患者出现并发症。其中猝死2例,喉头痉挛、气管痉挛,堵塞呼吸道可能为其死亡原因;术后切口皮下血肿3例,经床头紧急清除血肿后呼吸困难解除;颈脊髓或神经根损伤6例,经脱水治疗后恢复满意;喉返神经损伤1例,喉上神经损伤3例,3个月内基本恢复正常;切口感染2例,经抗感染、换药治疗后愈合;脑脊液漏2例,经局部适度加压后愈合;钢板螺钉松动钛网移位1例,经再次手术取出钢板,重新放置钛网植骨,钢板重新固定,3个月后植骨融合;植骨未愈合2例,均再次手术植骨钢板固定,3个月后植骨融合;内置物下沉、椎间高度丢失13例,经颈领固定,3-6个月内均获得椎间融合;相邻节段退变19例,无症状未特殊处理;颈部疼痛27例,给予口服非甾体药物,21例患者疼痛缓解。结论:颈椎病前路手术可发生多种并发症,应积极预防及进行相应的处理。  相似文献   

3.
目的总结颈椎前路手术并发症的原因及预防治疗措施。方法63例患者行颈椎前路手术,其中颈椎骨折脱位合并脊髓损伤28例,脊髓型颈椎病31例,颈椎结核3例,颈椎肿瘤1例。采用颈前横切口或斜切口,颈椎病行单节段椎间盘刮除减压,双节段椎体次全切除减压,三节段分别行椎间盘切除减压;肿瘤行椎体切除;结核行病灶清除。多数采用自体三面皮质骼骨植骨,带锁钢板固定,少数采用钛网髂骨植骨融合及椎间Cage植骨融合。结果共出现并发症14例。其中喉返神经损伤2例,脑脊液漏1例,脊髓损伤症状加重3例,钢板螺钉位置不当或松动4例,食道瘘1例,顽固性低钠低氯血症1例,急性胃黏膜病变1例,应激性溃疡1例。经相应治疗后12例治愈,2例死亡。结论手术直接并发症与手术者的熟练程度、手术技巧、手术经验密切相关。手术间接并发症与患者病情轻重及其他器官功能状态密切相关。术前正确评估病情、正确选择手术方式和手术时机、术中规范及熟练操作、加强围手术期观察和处理是减少手术并发症的关键。  相似文献   

4.
前路手术治疗脊髓型颈椎病的疗效分析   总被引:4,自引:0,他引:4  
目的总结颈椎前路减压,自体髂骨植骨或加钢板内固定治疗脊髓型颈椎病的临床效果。方法对28例前路颈椎手术患者进行分析,19例患者常规颈椎前路减压植骨融合手术,9例加用钢板内固定,所有病例术后都行X线检查,21例进行3~12个月随访(平均6个月)。结果术后症状有明显缓减,脊髓功能明显恢复者占76.19%,术后6个月植骨融合率达到100%,无钢板断裂或螺钉松动、滑脱。结论前路减压植骨或钢板内固定是治疗脊髓型颈椎病满意而有效的治疗方法。  相似文献   

5.
目的评价颈椎前路减压植骨内固定治疗颈椎骨折合并颈脊髓损伤的临床疗效。方法对215例颈椎骨折合并颈脊髓损伤的患者施行颈椎前路减压、自体髂骨植骨和颈椎带锁钛板内固定术。术后定期复查X线片,判定脊髓功能恢复情况。结果随访184例患者,平均随访时间3.5年。术后3个月植骨块获得骨性愈合,颈椎椎间高度和生理曲度维持满意,无内置物并发症,172例患者神经功能提高1~2级,仅12例A级患者神经功能无恢复。结论颈椎骨折合并颈脊髓损伤应尽早行前路减压、植骨、钛板内固定术,有利于脊髓功能恢复,能使损伤节段获得即刻、坚强的稳定,方便护理和功能锻炼。  相似文献   

6.
颈椎前路减压带锁钛板内固定治疗颈椎损伤   总被引:1,自引:0,他引:1  
目的评价颈椎前路减压带锁钛板内固定治疗颈椎骨折并脊髓损伤的临床疗效。方法对46例颈椎骨折并脊髓拟伤的患皙施行颈椎前路臧压、自体髂骨植骨和颈椎带锁钛板内固定。术后定期复查X线片,判定脊髓功能恢复情况,结果随访41例,平均随访时间2.5年。术后3个月植骨块获得骨性融合,颈椎椎间高度和生理曲度维持满意,无内置物并发症,脊髓功能平均提高1级。结论颈椎骨折并脊髓损伤前路减压、应用带锁钛板内崮定有利植骨融合和事建颈椎稳定。  相似文献   

7.
Orion钢板内固定治疗下颈椎骨折脱位   总被引:3,自引:0,他引:3  
目的探讨颈前路Orion钢板治疗下颈椎骨折脱位的优点及疗效。方法对36例下颈椎骨折脱位的患者,其中交通事故伤16例,高处坠落伤10例,重物砸伤5例,摔伤5例。采用经前路伤椎椎体次全切除减压、复位、自体髂骨植骨及Orion钢板固定的方法进行手术治疗。结果术后全部病例经随访观察,大部分症状获得改善.植骨在3个月内牢固融合,11例恢复正常工作.13例生活自理。颈椎椎间高度、生理曲度维持良好,无钢板、螺钉折断、滑脱等并发症。结论对于下颈椎骨折脱位宜选用颈前路Orion钢板治疗,前路手术除可达减压、复位、恢复颈椎椎间高度和生理曲度外,更重要的是可重建颈椎即刻稳定性,防止继发性脊髓损伤。有利于神经功能恢复。  相似文献   

8.
脊髓型颈椎病前路手术并发症的临床分析   总被引:2,自引:1,他引:1  
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。  相似文献   

9.
颈椎翻修手术的原因及对策   总被引:1,自引:1,他引:0  
目的 探讨颈椎翻修术的适应证、手术方式及其临床疗效.方法 自1998年4月~2007年12月,对21例颈椎手术后患者进行了翻修手术.翻修手术距离首次手术的时间2~42个月,平均15.3个月.所有病例均出现临床症状,其中表现为放射性颈肩痛16例、颈部活动受限5例,原有的脊髓受压表现加重8例,再次出现新的脊髓压迫症状7例.首次手术的术前诊断包括:下颈椎骨折脱位6例,神经根型颈椎病2例,脊髓型颈椎病9例,颈椎不稳4例.手术方式包括:单纯前路减压加自体髂骨植骨4例,前路减压加颈椎前路钢板固定8例,前路减压加Cage融合2例,前路椎体次全或全切除加内固定3例,后路CerviFix单纯内固定3例,后路双开门减压1例.结果 本组术后疗效优良13例(61.9%),好转6例(28.6%),无效及加重各1例(9.5%).21例术前评分2~14(8.65±0.37)分,术后8~16(14.27±0.69)分,差异有显著性(P<0.01).植骨于术后3~6个月融合.未出现喉上、喉返神经损伤、气管食管漏、脑脊液漏以及呼吸系统并发症.结论 颈椎翻修术式视具体情况而定,术前宜详细制定手术方案,彻底减压与正确的固定是手术成败的关键.  相似文献   

10.
目的探讨颈椎病前路减压后,应用自体髂骨植骨加前路钢板内固定、钛网植骨加前路钢板内固定、多枚颈椎钛金属Vigor椎间融合器及多枚聚醚醚酮(PEEK)融合器等不同重建方式,在恢复颈椎稳定性,维持颈椎病疗效的应用价值。方法总结2001年-2006年82例脊髓型颈椎病,采取椎体次全切+自体髂骨植骨+Windows钢板内固定术、椎体次全切+钛网植骨+Windows钢板内固定术、多个单间隙减压+颈椎Vigor椎间融合器及多个单间隙减压聚醚醚酮(PEEK)界面固定治疗。结果平均随访1.5年,82例患者颈椎生理前凸及椎间隙高度恢复满意,神经功能得到不同程度恢复。结论颈椎病前路手术后的神经功能恢复与减压的彻底性及脊髓受压变性密切相关,手术应达到充分减压,彻底解除脊髓压迫。应用自体髂骨植骨加前路钢板内固定、钛网植骨加前路钢板内固定、多枚颈椎钛金属Vigor椎间融合器及多枚聚醚醚酮(PEEK)融合器等不同重建方式,能使颈椎即刻稳定,维持颈椎生理曲度及椎间高度,有利于维持颈椎病的远期疗效。  相似文献   

11.
328例颈椎前路手术并发症的分析   总被引:7,自引:0,他引:7       下载免费PDF全文
目的 总结颈椎前路手术的并发症 ,分析原因并提出预防措施。方法  1 989年 5月~2 0 0 0年 3月颈椎前路手术 (减压 椎间融合术 ) 32 8例 ,其中颈椎病 1 75例 ,颈椎间盘突出症 97例 ,颈椎骨折、脱位 56例。结果 随访 6个月~ 1 1年 (平均 32个月 ) ,发生并发症 38例 ,其中喉上神经损伤 5例 ,喉返神经损伤 4例 ,植骨块部分滑出 5例 ,植骨不融合 1 9例 ,BAK沉降 3例 ,颈动脉窦综合征 1例 ,睡眠性窒息 1例。结论 熟悉颈椎前路手术解剖 ,操作轻柔 ,植骨、内固定合理 ,可以减少或避免并发症的发生  相似文献   

12.
颈椎前路手术早期并发症原因分析及对策   总被引:66,自引:2,他引:64  
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。  相似文献   

13.
Subsidence of stand-alone cervical cages in anterior interbody fusion: warning   总被引:10,自引:0,他引:10  
Anterior cervical decompression and fusion with anterior plating of the cervical spine is a well-accepted treatment for cervical radiculopathy. Recently, to minimise the extent of surgery, anterior interbody fusion with cages has become more common. While there are numerous reports on the primary stabilising effects of the different cervical cages, little is known about the subsidence behaviour of such cages in vivo. We retrospectively reviewed eight patients with cervical radiculopathy operated upon with anterior discectomy and fusion with a stand-alone titanium cervical cage. During surgery, only the cartilage portion of the end plate was removed and the cages were filled with autologous cancellous bone graft from the iliac crest. To assess possible subsidence or migration, three different radiographic measurements in the sagittal plane were taken for each case, postoperatively and at the latest follow-up. Subsidence was defined as any change in at least one of our parameters of at least 3 mm. Follow-up time was 12–18 months (average 15 months). Five of the nine fused levels had radiological signs of cage subsidence. No posterior or anterior migration was observed. However, subsidence did not correlate with clinical symptoms in four of the five patients. The remaining patient with signs of subsidence, whose neck pain and neurologic symptoms had regressed in the early postoperative course, suffered recurrence of radiculopathy 6 months after the surgery. Her symptoms were explained by the subsidence of the cage and the subsequent foraminal stenosis observed on the magnetic resonance imaging (MRI) scan. At 15 months' follow-up, her cage was broken. Our preliminary results, so far limited in number, represent a serious warning to the proponents of stand-alone cervical cages  相似文献   

14.
后路BAK椎间融合术治疗腰椎滑脱症的并发症分析   总被引:57,自引:3,他引:54  
目的 统计和分析后路BAK椎间融合器治疗腰椎滑脱症的并发症。方法 对118例腰椎峡部崩裂性滑脱患者行后路BAK椎间融合术,统计术中,术后并发症(包括硬脊膜撕裂,神经根损伤,融合器位置不佳,融合器后移,沉陷和继发性粘连性蛛网膜炎等),分析原因并探讨预防措施。结果 118例患者中,术中并发症13例,占11%,其中硬脊膜撕裂4例(3.4%),神经根损伤3例(2.5%),BAK椎间融合器位置不佳9例(7.6%),2例硬脊膜撕裂和1例神经根损伤同时存在融合器位置不佳,术后并发症9例,占7.6%,其中融合器后移3例(2.5%),融合器沉陷4例(3.4%),继发性粘连性蛛网膜炎2例(1.7%),部分或可疑不融合5例(4.2%)。2例融合器后移和1例沉陷均呈部分或可疑不融合,2例融合器沉陷伴继发性粘连性蛛网膜炎。结论 后路BAK椎间融合术有一定的创新性和优越性,但手术创伤大,技术要求高,可能发生各种并发症,应严格掌握手术适应证并规范手术操作。  相似文献   

15.
Anterior cervical reconstruction using titanium cages with anterior plating.   总被引:39,自引:0,他引:39  
M E Majd  M Vadhva  R T Holt 《Spine》1999,24(15):1604-1610
STUDY DESIGN: A preliminary outcome assessment study of titanium cage implants with anterior cervical plating in anterior cervical reconstruction. OBJECTIVES: To evaluate the efficacy and safety of using titanium cage implants and anterior plating in cervical reconstruction. SUMMARY OF BACKGROUND DATA: Anterior decompression and interbody fusion is a widely accepted surgical treatment for patients with cervical spondylosis. Tricortical iliac crest autograft has been the gold standard but is associated with morbidity at the bone graft donor site, whereas allograft fibula is associated with pseudarthrosis. Problems such as pseudarthrosis, graft collapse, and extrusion still persist with the accepted method of harvesting and implanting bone autografts. METHODS: Thirty-four patients were treated by channel corpectomy followed by placement of a titanium cage packed with autogenous bone graft from the vertebral bodies to reconstruct the anterior column. An anterior cervical plate was added in 30 of 34 cases that involved decompression of two or more levels. The follow-up period ranged from 24 to 56 months, with an average follow-up period of 32 months, and included examination and radiography. RESULTS: Six months after surgery, there was radiographic evidence of fusion in 97% of the patients. Eighty-eight percent of the patients (30 of 34) did not experience any complications (neither cage dislodgment nor hardware failure). Four patients had complications that included pseudarthrosis (1), extruded cage (1), cage in kyphosis (1), and radiculopathy (1). CONCLUSIONS: Titanium cages provide immediate strong anterior column support with minimum hardware complications and avoid bone graft-site morbidity. Titanium cages, with concomitant use of anterior plating, offer an effective and safe alternative to bone autografts.  相似文献   

16.
Cervical fusion cages have been developed to provide an anterior structural support without harvesting tricortical iliac bone. Limited numbers of investigations have focused on pitfalls of anterior cervical fusion using cage implants. The objective of this study is to report clinical results and implant-related complications in anterior cervical fusion using titanium mesh and anterior plating. Twenty-four cases with anterior cervical fusion using a titanium mesh with local autograft and anterior plating were reviewed. One-level fusion was performed in 7 cases, and 17 patients underwent two-level fusion with corpectomy. The mean follow-up period was 27 months. Radiographic assessment included sagittal alignment, fusion status, and complications related to cage implants. Iliac bone graft harvesting was obviated in all the patients, whereas 15 patients required concomitant use of ceramic bone substitute. Sagittal alignment of the operative level was lordotic in 19 cases (79%) and neutral in 5 cases (21%) at the final follow-up. No late kyphotic collapse was observed. Twenty-three cases (96%) achieved a solid fusion, whereas the time to fusion was averaged 6.2 months. Cage subsidence frequently occurred in 42% of upper vertebrae and 50% of lower vertebrae. The use of titanium mesh and local autograft for anterior cervical fusion obviated the need for harvesting iliac bone block and provided structural anterior column support. However, it required a longer period to achieve a solid fusion when compared with tricortical iliac autograft. Cage subsidence was frequently observed in the early postoperative period.  相似文献   

17.
Interbody fusion cages are small hollow implants that are inserted into the intervertebral space to restore physiological disc height and to allow bony fusion. They sometimes cause clinical complications due to instability, subsidence or dislocation. These are basic biomechanical parameters, which influence strongly the quality of a fusion device; however, only few data about these parameters are available. Therefore, the purpose of the present study was to investigate the primary stabilizing effect of four different cervical fusion devices in in vitro flexibility tests. Twenty-four human cervical spine segments were used in this study. After anterior discectomy, fusion was performed either with a WING cage (Medinorm AG, Germany), a BAK/C cage (Sulzer SpineTech, USA), an AcroMed cervical I/F cage (DePuy AcroMed International, UK) or bone cement (Sulzer, Switzerland). All specimens were tested in a spine tester in the intact condition and after implantation of one of the four devices. Alternating sequences of pure lateral bending, flexion-extension and axial rotation moments (+/- 2.5 Nm) were applied continuously and the motions in each segment were measured simultaneously. In general, all tested implants had a stabilizing effect. This was most obvious in lateral bending, where the range of motion was between 0.29 (AcroMed cage) and 0.62 (BAK/C cage) with respect to the intact specimen (= 1.00). In lateral bending, flexion and axial rotation, the AcroMed cervical I/F cages had the highest stabilizing effect, followed by bone cement, WING cages and BAK/C cages. In extension, specimens fused with bone cement were most stable. With respect to the primary stabilizing effect, cages, especially the AcroMed I/F cage but also the WING cage and to a minor extent the BAK/C cage, seem to be a good alternative to bone cement in cervical interbody fusion. Other characteristics, such as the effect of implant design on subsidence tendency and the promotion of bone ingrowth, have to be determined in further studies.  相似文献   

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