腰骶段脊柱结核病灶清除术的并发症

目的：探讨腰骶段脊柱结核病灶清除术的并发症及其防治。方法整群选取2013年1月—2016年1月该院收治的腰骶段脊柱结核患者64例,病例纳入标准为经手术治疗的发生于腰骶段(L4~S1)脊柱结核病例,其中有24例出现并发症,平均42.3岁。手术并发症为：①髂血管损伤15例,②髂血管血栓形成8例,③植骨块松动移位8例,④病灶清除不彻底6例,⑤伤口窦道经久不愈3例,⑥脑脊液漏3例,⑦神经症状加重2例。处理：①立即修复髂血管,②溶栓治疗,③返修手术调整髂骨块,再次病症清除,④延长引流管放置时间,加强换药,⑤应用神经营养药物。结果全部病例经2月~4年随访,植骨融合良好20例,下肢神经症状缓解16例,髂血管恢复再通8例,伤口一期愈合16例,3例窦道延迟愈合时间6月~2年。结论并发症总结及处理：①髂血管损伤最常见,主要是髂内血管损伤多见。②植骨块移位。③病灶清除不彻底与窦道形成有一定的关系。④脑脊液漏和神经症状加重。

Complications of Surgical Removal of Spinal Tuberculosis in the Lumbar and Sacral Spine

Objective To investigate the complications and the prevention and treatment of tuberculosis in the lumbar and sacral spinal tuberculosis. Methods January January 2013 to 2016 were admitted to the lumbosacral spinal tuberculosis a total of 64 cases. The cases included in the standard occurring in the lumbosacral segment(L4~ S1) spinal tuberculosis cas-es treated by surgery. Among them, 24 cases of complications, with an average of 42.3 years. Surgical complications: ①iliac vascular injury in 15 cases, ②iliac vascular thrombosis formation in 8 cases,③bone graft loosening in 8 cases,④lesions is not completely clear in 6 cases,⑤ the wound sinus prolonged does not heal in 3 cases, ⑥ cerebrospinal fluid leakage in 3 cases, ⑦the neurological symptoms aggravated in 2 cases. Treatment: ①immediate reconstruction of iliac blood vessels, ②thrombolytic therapy,③surgical repair adjustment iliac bone, to clear the disease again,④the extension of the drainage tube placement time, ⑤strengthening the dressing and application of neurotrophic drugs. Results All the cases after 2 months to 4 years follow-up, planting good bone fusion in 20 cases, lower limb neurological symptoms remission in 16 cases, iliac ves-sels restore recanalization in 8 cases, the wounds healed in 16 cases, 3 cases of sinus delay healing time was 6 months to 2 years. Conclusion Summary and treatment of complications:①iliac vascular injury is the most common, mainly in the com-mon iliac vascular injury. ②bone graft block. ③were not completely clear and sinus formation have a certain relationship.④cerebrospinal fluid leakage and neurological symptoms.