退变性腰椎疾病术后并发症分析

目的探讨经腰椎后路手术治疗腰椎间盘突出症出现术后并发症的原因,提出预防措施。方法 2009年3月至2011年5月我科共开展腰椎间盘手术400例,按照手术方式分为A、B两组,A组28例为半椎板减压单侧固定组,B组372例为全椎板减压双侧固定组,均行钉棒内固定椎体间植骨Cage融合术,术后62例发生并发症。结果 3例行单侧内固定术后健侧出现剧烈的神经根刺激症状,均经过再次手术探查后症状缓解;17例行L4～5及L5S1椎间盘突出髓核摘除植骨Cage融合内固定术,术后双下肢麻木症状存在约1年,经过保守及营养神经治疗后症状大部分缓解;15例L4～5椎间盘突出症,给予髓核摘除植骨融合内固定术,术后出现双下肢症状缓解不明显,且术后1年伴有发凉、麻木等症状;25例全椎板减压双侧固定术后出现单纯脑脊液漏,2例出现术后感染,其中1例并发化脓性脑膜炎。统计两组手术时间、出血量及Oswestry评分,采用SPSS 11.0软件进行统计学分析。结论腰椎间盘突出症髓核摘除Cage融合内固定术后可能会出现一些术后并发症,有时这些症状会持续较长时间,在治疗上首先应明确诊断,慎重选择内固定,术中注意椎管减压的程度和范围,同时掌握正确的椎间植骨方法。

Analysis of Postoperative Remnant Complications in Degenerative Lumbar Diseases

Objective To explore the causes and the prevention of postoperative residual complications in posterior lumbar surgery for lumbar disc herniation.Methods 62 cases of postoperative residual complications in 400 cases of lumbar disc surgery from March 2009 to May 2011 were analyzed.Results 3 cases after unilateral internal fixation suffered from the very severe nerve root irritation in the normal lower limb.Their symptoms were relieved after surgical treatment again.There were 17 cases with L4~5 and L5Sl intervertebral disc nucleus pulposus removal and cage fusion and internal fixation,with postoperative lower limbs numbness lasting for about 1 year.The symptom were relived after conservative treatment.There were 15 cases with lumbar 4~5 intervertebral disc nucleus pulposus removal,grafting fusion and internal fixation,whose postoperative lower limbs symptoms were not improved obviously.And there were cool feeling,numbness and other symptoms after 1 year.Cerebrospinal fluid leak was found in 25 cases after full laminectomy with bilateral fixation.There were 2 cases with postoperative infection and 1 case with purulent meningitis.SPSS 11.0 statistical package was used to compare the data of operation time,bleeding volume and Oswestry scores between the two groups of semi-laminectomy with unilateral fixation and full laminectomy with bilateral fixation.Conclusion Some postoperative residual symptoms may be found in the cases of lumbar disc herniation after nucleus pulposus removal,cage fusion and internal fixation.Sometimes these symptoms will last a long time.A accurate diagnosis is required.The internal fixation,decompression scope of the spinal canal and method of interbody fusion shall be determined carefully.