颈椎前路手术并发症原因分析及防治

目的观察颈椎前路手术并发症发生率,分析原因并探讨防治的决策。方法回顾2001年1月～2010年12月共行颈椎手术172例,有并发症35例,对各种并发症的因素及防治进行分析。结果并发症总发生率为20.3%,35例均获得随访,随访时间33～81个月,平均(62±8)个月,喉返神经或喉上神经损伤9例,术后颈部血肿6例,伤口感染2例,钢板螺钉松动5例,颈脊髓或神经根刺激损伤5例,脑脊液漏1例,假关节形成3例,术后颈部轴性疼痛5例,食管漏1例,骨块移位2例,其中,合并发生钢板螺钉松动、食管漏1例,合并发生钢板螺钉松动、假关节形成3例。结论颈椎前路手术伴有较高的并发症发生率,其原因是复杂的,主要与伤情严重程度及术者操作熟练程度、围手术期处理相关;严格的围手术期处理,提高手术操作技巧,及时正确处理并发症,是防治并发症的有效手段。

PREVENTION AND TREATMENT OF COMPLICATIONS IN ANTERIOR CERVICAL SPINE SURGERY

Objective To observe anterior cervical surgical complication rate,analyze the causes and discuss the prevention and treatment of complications.Methods A retrospective analysis was preformed on 172 cases treated with anterior cervical surgical between Jan.2001 and Dec.2010.35 complications occurred and followed up for 33～81（62 ± 8） months.Results 35 complications occurred in 172 patients and the incidence was 20.3%.Including superior laryngeal nerve or recurrent laryngeal nerve injuries in 9,cervical haematoma in 6,incision infection in 2,1oosening of screw or plate fixation in 5,aggravation of spine cord or nerve root injury in 5,cerebrospinal fluid fistula in 1,pseudarthrosis in 3,Neck axial pain in 5,esophageal fistula in 1,migration of bone graft in 2,especially,1oosening of screw fixation and esophageal fistula in 1,1oosening of screw fixation and pseudarthrosis in 3.Conclusion Anterior cervical operation are associated with a higher rate of complication,its reason is complex,mainly with injury situation and the performer operation proficiency,perioperative management related;Strict perioperative management,improve operation skill,timely and correctly handling complications,are effective means to prevent complications.