颈椎椎板成形侧块螺钉内固定术的并发症分析及防治

目的:探讨颈椎后路单开门椎板成形侧块螺钉固定术治疗颈椎管狭窄并发症的发生及防治.方法:对2008年2月至2011年7月行颈椎后路单开门椎板成形侧块螺钉固定术治疗的33例颈椎管狭窄病例进行回顾性分析.分别于术前、术后1、6个月对患者进行随访及JOA评分,并按症状改善率进行疗效评估,统计疗效的优良率及并发症的发生率.33例患者中出现并发症6例,其中男2例,女4例,对并发症原因进行分析.结果:33例均获随访,时间6个月～2年,平均10.3个月.根据JOA改善率得出术后6个月疗效优良率为78.8％,并发症发生率18.2％.其中2例患者出现轴性症状,侧块螺钉拔脱1例,脑脊液漏并术口开裂2例,出现神经根麻痹1例.其并发症发生与手术设计及操作、颈椎生理曲度的改善程度、术后管理、患者术后的配合密切相关.结论:单开门椎板成形侧块螺钉固定术治疗颈椎管狭窄疗效良好,轴性痛发生率低,但要避免并发症的发生,重视术前检查及准备,手术中仔细操作,加强术后管理及患者配合必不可少.

Analysis of postoperative complication and its preventive measure of cervical open-door expansive laminoplasty with lateral mass screw fixation

Objective: To explore the postoperative complication and its preventive measure of cervical open-door expansive laminoplasty with lateral mass screw fixation in treating cervical canal stenosis. Methods: From February 2008 to July 2011,33 patients with cervical canal stenosis underwent cervical open-door expansive laminoplasty with lateral mass screw fixation. JOA score was used to evaluate clinical effects before and after operation. Of them,complications occurred in 6 cases,male in 2 cases and female in 4 cases. The reason of complications were analyzed. Results: All the patients were followed up from 6 months to 2 years with an average of 10.3 months. The improvement rate of JOA was 78.8% and incidence rate of complication was 18.2%(6 cases). There were 2 cases of axiality symptoms,1 case of lateral mass screw pulled-out,2 cases of cerebrospinal fluid leakage with wound dehiscence,1 case of nerve root parlysis. These complications correlated with operative design,manipulation,improved degree of cervical curvature,postoperative management and cooperation of patient. Conclusion: As an effective treatment,cervical open-door expansive laminoplasty with lateral mass screw fixation has lower incidence of axiality pain. Preoperative examination,postoperative management,meticulous surgical skill are very important to avoid complications.