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颈椎后纵韧带骨化症手术并发症探讨 总被引:2,自引:0,他引:2
[目的]探讨颈椎后纵韧带骨化症(OPLL)手术主要并发症的原因及对策。[方法]对2002年3月~2006年5月85例颈椎后纵韧带骨化症手术治疗病例进行回顾性分析。其中连续长节段骨化行颈后路全椎板切除减压内固定68例,发生并发症13例;孤立型或短节段骨化行颈前路椎体次全切减压植骨内固定17例,发生并发症3例。[结果]术后获得随访66例,随访期3~25个月,平均13个月。颈后路并发症:颈肩痛8例,给予消炎止痛药、脱水、理疗等保守治疗,术后2~20周患者疼痛缓解,恢复基本满意,其主要原因与减压后脊髓漂移神经根受牵拉或手术操作导致神经根受刺激或损伤有关。2周内缓解者可能与手术创伤局部组织水肿肌肉痉挛所致。术后不全瘫或症状加重4例,经药物及高压氧等治疗,3例恢复理想,1例恢复欠佳,不全瘫发生主要与手术减压后脊髓再灌注损伤有关。术后血肿2例,均经及时发现即刻手术探查血肿清除、激素冲击治疗而获得恢复,术中止血不彻底或手术创面渗血、引流管引流失败是其主要原因。脑脊液漏1例,经脱水、局部适当包扎及颈部制动,于术后3d脑脊液漏停止,切口愈合良好。手术切口感染2例,经抗感染、局部清创缝合等治疗术后20d左右获得愈合。前路并发症:术后不全瘫2例,经甲强龙冲击,神经营养药(弥可保)、高压氧治疗,术后20~30d完全恢复;脑脊液漏1例。内置物相关并发症:前路钛网下沉1例,后路内固定螺钉脱落1例(单枚)。[结论]颈椎后纵韧带骨化无论行后路或前路手术可发生多种并发症,有些是难以避免的,而有些则是可以经过努力预防或杜绝的,术前准备充分,术中小心操作,术后加强管理,是减少后纵韧带骨化手术并发症的关键。 相似文献
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椎弓根钉固定的侧后方植骨融合和径后路椎体间融合治疗老年人腰椎滑脱症的效果评价 总被引:1,自引:0,他引:1
Objective Clinical and radiographic results in 30 consecutive patients undergoing posterior lumbar fixation and posterior facet joint or posterior interbody fusion for Meyerding Grade Ⅱ/Ⅲ spendylolisthesis were assessed: (1) to address the suitability of a dynamic stabilization; and (2) to investigate whether there are differences in terms of clinical and functional results between these two types of arthrodesis. Methods Fourteen patients underwent posterior inteffacet fusion (PLF) and implantation of TSRH-3D system. Posterior lumbar interbody fusion (PLIF) and placement of the same system were performed in 16 patients. Clinical, economic, functional and radiographic data were recorded both pre- and postoperatively. Results The average changes in Prolo Scale of economic and functional scores were 1.25 and 1.64 respectively, in patients undergoing posterior fusion; the average measured vertebral slippage was 48.6% (range 32% -65%) preoperatively and 17. 5% (range 15% -25%) postoperatively. In patients undergoing PLIF, the average changes in economic and functional score were 1.18 and 1.39 respectively, and the average preoperative vertebral slippage was 44. 2% (range 30% - 55%) versus 20. 3% (range 18% -26%) postoperatively. Conclusion The use of a segmental pedicle screw fixation with TSRH-3D was able to successfully combine the goal of solid fusion with the requirements of nerve root decompression. When these two fusion techniques were compared, PLIF was superior to PLF because of an overall superior reliability and system resistance. But their clinical outcomes did not differ greatly (P > 0. 05). 相似文献
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Objective Clinical and radiographic results in 30 consecutive patients undergoing posterior lumbar fixation and posterior facet joint or posterior interbody fusion for Meyerding Grade Ⅱ/Ⅲ spendylolisthesis were assessed: (1) to address the suitability of a dynamic stabilization; and (2) to investigate whether there are differences in terms of clinical and functional results between these two types of arthrodesis. Methods Fourteen patients underwent posterior inteffacet fusion (PLF) and implantation of TSRH-3D system. Posterior lumbar interbody fusion (PLIF) and placement of the same system were performed in 16 patients. Clinical, economic, functional and radiographic data were recorded both pre- and postoperatively. Results The average changes in Prolo Scale of economic and functional scores were 1.25 and 1.64 respectively, in patients undergoing posterior fusion; the average measured vertebral slippage was 48.6% (range 32% -65%) preoperatively and 17. 5% (range 15% -25%) postoperatively. In patients undergoing PLIF, the average changes in economic and functional score were 1.18 and 1.39 respectively, and the average preoperative vertebral slippage was 44. 2% (range 30% - 55%) versus 20. 3% (range 18% -26%) postoperatively. Conclusion The use of a segmental pedicle screw fixation with TSRH-3D was able to successfully combine the goal of solid fusion with the requirements of nerve root decompression. When these two fusion techniques were compared, PLIF was superior to PLF because of an overall superior reliability and system resistance. But their clinical outcomes did not differ greatly (P > 0. 05). 相似文献
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[目的]探讨齿状突骨折合并C2、3脱位治疗方法,并分析其疗效. [方法]本组16例,男11例,女5例;年龄19~54岁,平均36岁,根据是否有合并伤分2组,A组:齿状突骨折合并Hangman骨折9例;B组:齿状突骨折合并C2、3间盘破裂、C2、3脱位;齿状突骨折根据Anderson-D'Alonzo分类:Ⅱ型骨折12例、Ⅲ型骨折4例;手术采取齿突中孔螺钉单纯固定4例;齿突螺钉固定加C2、3融合内固定6例;齿突螺钉固定加后路C2、3固定术6例;术后颈围固定3个月. [结果]16例患者经6个月~3年随访,X线片均示骨性愈合;A、B 2组无固定并发症(内置物松动、折弯、断钉).无神经功能加重的患者. [结论]对Hanggman骨折可采用颅骨小重量牵引,C2、3不稳的齿突骨折患者,宜早期手术. 相似文献
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老年人腰椎退变性侧凸症手术治疗的临床分析 总被引:1,自引:0,他引:1
[目的] 探讨65岁以上老年人腰椎退变性侧凸症手术治疗的可靠性、手术方法及术后效果.[方法]回顾性分析自2004年9月~2008年4月经手术治疗的64例退变性脊柱侧弯的矫正效果、并发症和随访结果.其病程6~120个月,平均45.2个月.对Cobb' s角<20°的23例患者,行选择性椎管或神经根管减压,经后路椎体间融合,短节段椎弓根钉棒系统固定;对Cobb' s角>20°的42例患者,行椎管减压,长节段固定侧弯矫正,后路椎体间融合及后外侧自体骨植骨融合术.[结果]全组病例术后平均侧弯矫正率为51.2%,疼痛缓解率88.3%,92%患者自诉生活质量得到明显改善,恢复了生活自理能力.平均随访37个月(6~48个月),随访期间矫正度数及椎间隙高度无丢失,融合器无移位.[结论]老年人腰椎退变性侧凸症的手术治疗应严格掌握手术适应证,充分减压,最大限度重建脊柱在冠状面和矢状面的平衡.老年患者病程长、往往伴随多器官疾病,应注意将手术创伤减少到最低程度,术后积极加强功能锻炼. 相似文献
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目的 探讨不同类型齿状突骨折的相应治疗方法 及临床效果.方法 对21例齿状突骨折患者根据Anderson-D'Alonzo分型进行不同方法 治疗:Ⅰ型骨折3例枕颌带牵引+6周后头颈胸石膏固定;Ⅱ型骨折13例行颅骨牵引复位后齿状突中孔螺钉固定;Ⅲ型骨折5例,颅骨牵引复位后1例行齿状突中空螺钉固定,4例行颈后路寰枢椎椎弓根螺钉固定.结果 随访6~48个月,平均9个月,骨折均获骨性愈合,未出现术后并发症.结论 齿状突骨折应按类型区别处理,Ⅰ型骨折、深Ⅲ型骨折应当采用保守疗法,Ⅱ型及浅Ⅲ型骨折使用齿状突中空螺钉固定术治疗可获得满意效果,对于不适合齿状突中空螺钉治疗的浅Ⅲ型骨折,可选用颈后路寰枢椎椎弓根螺钉固定术. 相似文献
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椎弓根钉固定的侧后方植骨融合和径后路椎体间融合治疗老年人腰椎滑脱症的效果评价 总被引:1,自引:0,他引:1
目的 观察应用椎弓根螺钉内固定技术,并分别结合侧后方融合(PLF)和经后路椎体间融合(PLY)两种方法 治疗老年人腰椎滑脱症的临床效果.方法 应用枢法模公司生产的TSRH-3D腰椎后路内固定系统治疗30例腰椎滑脱症患者,其中14例患者实施TSRH-3D内固定加侧后方植骨融合(PLF);16例患者行TSBH-3D内固定加经后路椎体问融合(PLIF),进行术前术后功能、症状评分.结果 30例患者均达到良好的融合效果;实施PLF患者,Prolo功能和症状评分分别为1.25和1.64;术前腰椎滑脱角为48.6%,术后恢复至17.5%.实施PLIF患者,Prolo功能和症状评分分别为1.18和1.39;术前腰椎滑脱角为44.2%,术后恢复至20.3%.结论 治疗成人腰椎滑脱症,应用TSBH-3D腰椎后路内固定系统可以获得牢固稳定,在保持腰椎术后功能恢复方面,PLIF优于PLF,但临床结果 尚无明显差异. 相似文献
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不同类型齿状突骨折的治疗方法及临床效果评价 总被引:1,自引:1,他引:0
田纪伟 王雷 董双海 赵庆华 夏天 吴振凯 王震 TIAN Ji-wei WANG Lei DONG Shuang-hai ZHAO Qing-hua XIA Tian WU Zhen-kai WANG Zhen 《中华创伤杂志》2009,25(7)
目的 探讨不同类型齿状突骨折的相应治疗方法 及临床效果. 方法 对21例齿状突骨折患者根据Anderson-D'Alonzo分型进行分类,并予以不同方法 治疗:Ⅰ型骨折3例行枕颌带牵引+6周后头领胸石膏固定;Ⅱ型骨折13例行颅骨牵引复位后,齿状突中空螺钉固定;Ⅲ型骨折5例,行颅骨牵引复位后,1例行齿状突中空螺钉固定,4例行颈后路寰枢椎椎弓根螺钉固定.结果 随访6~48个月,平均9个月,骨折均获骨性愈合,未出现术后并发症. 结论 齿状突骨折应按类型区别处理,Ⅰ型骨折、深Ⅲ型骨折应当采用保守疗法,Ⅱ型及浅Ⅲ型骨折使用齿状突中空螺钉同定术治疗可获得满意效果,对于不适合齿状突中空螺钉治疗的浅Ⅲ型骨折,可选用颈后路寰枢椎椎弓根螺钉固定术. 相似文献
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目的 探讨复杂枢椎骨折合并相邻节段不稳的临床、影像学特点,提供合理的手术治疗策略.方法 回顾分析手术治疗且资料完整的21例枢椎骨折患者,男14例,女7例;平均年龄34岁.根据枢椎骨折的类型及其相邻寰枢关节、C2/3椎间的稳定情况,分别采用以下手术方式:(1)前路C2/3椎间盘切除及植骨、颈前路钢板固定;(2)齿状突螺钉固定;(3)后路C1~2椎弓根、颈椎侧块螺钉固定或联合前后路手术,稳定上颈椎.结果 21例全部获得6~36个月随访(平均12个月),术后佩戴颈围3个月,3个月均获得骨性融合,颈椎伸屈侧位片显示颈椎稳定,无内固定松动、脱出及断裂,无椎动脉损伤、神经损伤、脑脊液漏及切口感染等手术并发症.5例脊髓损伤神经功能恢复良好.结论 对于枢椎骨折,在确定骨折的类型及准确判断相邻寰枢关节、C2/3稳定性受破坏程度的基础上,通过手术治疗,可取得良好的疗效. 相似文献