胸腰椎骨折伴截瘫前路减压固定术并发症分析

目的探讨胸腰椎骨折前路减压固定术并发症产生原因和处理对策。方法1998年2月-2004年8月，收治胸腰椎骨折伴截瘫采用前路减压固定术者204例，近期并发症34例51例次，发生率为25．0％。测量术前、术后及随访时的胸腰椎正侧位X线片，随访神经功能康复状况。结果术后发生感染1例；脑脊液漏7例；气胸8例；血气胸2例；肋间神经损伤5例；腰神经根损伤2例；脊髓损伤加重2例；生殖股神经损伤3例；股外侧皮神经损伤2例；术侧肢体皮温升高8例；深静脉血栓形成3例。术后半个月内复查X线片示：脊柱侧凸畸形3例，后凸畸形5例。占4．0％。84例获得随访，时间3个月～6年，平均2．5年。其中慢性腰背痛7例，脊柱后凸畸形6例，侧凸畸形5例。无断钉、断棒、内固定松动、假关节形成等并发症。结论熟练掌握胸腰椎前路减压操作技术、减轻术中创伤、恰当合理的康复指导，可避免大多数并发症。

Analysis of complication in anterior decompression and fixation technique for thoracolumbar fractures in cases with concomitant paraplegia

Objective To discuss causation and clinical treatment of complication in anterior decompression and fixation technique (ADFT) for thoracolumbar fractures with associated paraplegia. Methods A total of 204 cases that had thoracolumbar fractures with paraplegia were operated with ADFT from 1998 to 2004. Of all, 51 times (34 cases) of complication took place. Change of Cob angle was measured according to X-film of thoracolumbar spine before and after operation. Meanwhile, sensation and motion of patients was evaluated. Results There was incision infection leading to septic cerebo-meningtis in one case, CSF leakage in seven, pneumothorax in eight, rib nerve-root injure in five, lumbar nerve-root injure in two, genitofemoral nerve injure in three, lateral femoral cutaneous nerve injure in two, kyphosis in three, deep venous thrombosis in three and eight times of skin-temperature change. X-film that was taken after operation for all patients showed scolisis in five cases. A follow up for 3-6 years (average 2.5 years) was performed in 84 cases, of which seven cases had chronic low-back pain, six scolisis and five kyphosis. No patient showed complications such as screw breakage, plate breakage, fixation device loosening and pseudo-articulation in thoracolumbar spine. Conclusions Many complications can be avoided if we master well anterior decompression and fixation technique of thoracolumbar fracture, reduce surgical trauma and give appropriate and rational guide for rehabilitation.