颈椎病前路择期手术术后早期并发症分析

目的：比较颈椎病前路择期手术后的各种早期并发症的发生率，分析并发症的危险因素。方法：研究2000～2003年的168例颈椎病前路择期手术患者的出院病历，选择可能常见或少见的危险因素，确定患者从术后至出院期间可能出现的各种早期并发症；采用统计学方法分析不同因素对早期并发症的影响，并用Logistic回归分析确定早期并发症发生的危险因素。结果：20．8％的患者有一种或多种并发症，病程长短对其影响较大；其中16．1％为非感染性手术并发症。病程和手术时间不同者差异有显著性；1．2％为感染性并发症，7．7％为其他医疗并发症，1例在住院期间接受无计划的二次手术，无院内死亡。手术持续时间过长和病程超过1年者被确定为危险因素，手术持续时间过长OR值为1．5，病程超过1年者OR值为2．8。结论：病程超过1年和手术时间过长者容易出现前路颈椎手术早期并发症，其危险性成倍增加。应努力缩短手术时间，避免过于繁琐的手术操作。尽量采用如异体骨移植等减少术中损伤的方法。

Evaluation of early complications of selective anterior cervical surgery

Objective The first objective of this retrospective study of a consecutive series of pa-tients, who suffered from cervical spondylotic disease, was to determine the rate of short postoperative com-plications of selective surgical treatment by anterior cervical approach. The second objective was to describe these early complications and search for related risk factors favoring their occurrence. Methods 168 pa-tients with cervical spondylosis underwent anterior surgery from January 1997 to January 2003, and were enrolled in this study. The age of patients ranged from 15 to 73 years with an average of 51.6 years. There were 111 males and 57 females. Possible early postoperative complications were identified and selected for analysis. Logistic regression was used to estimate the independent effects of patient characteristics on short-term outcomes.Results The surgical complications of hemorrhage, dural tear, neurological symptoms, wound disruption, spinal cord injury and so on happened in 26 cases, the infectious complications of lung and urinary tract appeared in 2 cases, and the other complications were 13. 20.8% of all patients had one or more early postoperative complications. Course of original disease had an obvious effect on all short term re-sults. The incidence of noninfectious complication was 16.1%. Course of original disease and long operative time might affect the rate of complication. The incidence of infection and other medical complications was 1.2% and 7.7% respectively. One patient needed reoperation, no in-hospital death happened. Course of dis-ease and longer operative time were risk factors to cause the occurrence of complications. The OR of long operative time is 1.5, and the long course of disease was 2.8. Conclusion Longer course of disease and longer operative time will increase the rate of early complications of selective anterior cervical operations. The operative time should be reduced, especially for patients with the history more than 1 year, and bone allograft may be used to prevent additional injury.