颈椎前路术后早期并发症特点、原因及其处理

目的探讨颈椎前路内固定术后早期并发症的特点、发生原因、对策和预防措施。方法回顾性分析自2010年1月~2016年12月中山大学孙逸仙纪念医院骨科单纯行颈椎前路内固定手术患者391例,其中颈椎病321例,颈椎外伤(骨折脱位、脊髓损伤)54例,颈椎肿瘤11例,颈椎感染5例。对上述病例术后早期并发症的特点、发生原因及处理进行总结分析。结果 391例患者中术后发生并发症共28例,占7.2%。不同颈椎疾患患者及不同节段数手术患者并发症发生率不同。存在并发症的患者中,术后一周仍存吞咽困难者6例,5例对症治疗后完全康复,1例未恢复;脊髓损伤加重者2例,1例术后1周再次行颈椎后路减压手术并获得恢复,1例术后经治疗无效死亡;血肿压迫者3例,均予以紧急手术清除血肿;喉上及喉返神经损伤共4例,经对症治疗后恢复;上呼吸道感染5例,伤口延迟愈合3例,脑脊液漏1例,尿潴留1例,下肢深静脉血栓1例,急性心梗1例,气胸1例,均予对症治疗后康复。结论颈椎疾患严重程度及节段数影响颈椎并发症的发生。术后严重的并发症可致严重后果。术前患者的综合评估、术前严格的准备,术中术者操作、助手密切的配合以及术后严格的观察处理是减少并发症发生的重点。

Characteristics，causes and treatment of early complications after anterior cervical spine surgery

［Abstract］ Objective To investigate the characteristics，causes，countermeasures and preventivemeasures of early complications after anterior cervical spine fusion and fixation. Methods A retrospective analysis of 391 cases with anterior cervical spine surgery were performed from January 2010 to December 2016 in Sun Yat?sen Memorial Hospital of Sun Yat?sen University. There were 321 cases of cervical spondylosis，54 cases of cervical spine trauma（fracture or dislocation，spinal cord injury），11 cases of cervical spondylosis，and 5 cases of cervical spine infection. The characteristics，causes and treatment of early postoperative complications were summarized and analyzed. Results Among 391 cases，a total of 28 cases（7.2%）occurred complications. The incidence of complications was different in cases with different cervical spine diseases and in different segments. Among the cases with complications，6 cases with dysphagia still occurred one week after the operation and 5 cases recovered completely after symptomatic treatment，but 1 case did not recover；2 cases with spinal cord injury became worse after the operation and 1 case totally recovered after posterior cervical decompression，but1 case died；3 cases with hematoma compression were treated with emergency operation to remove hematoma and recovered；17 cases recovered after symptomatic treatment，including 4 cases withrespiratory tract infection，3 cases with delayed wound healing，1 case with cerebrospinal fluid leakage ， 1 case with urinary retention，1 case with deep venous thrombosis of lower extremity，1 case with acute myocardial infarction and 1 case of pneumothorax. Conclusion The severity of cervical spine disease and the number of segments affect the occurrence of cervical complication. Severe complications after surgery can lead to serious consequences. Comprehensive evaluation of preoperative patients，strict preoperative preparation，intraoperative operation close coordination of assistant，and strict postoperative observation are the key points to reduce complications.