胸、腰段脊柱脊髓损伤外科治疗失误的处理

目的:分析急性胸、腰段脊柱脊髓损伤外科治疗失误的主要原因,探讨处理原则。方法:对104例首次外科治疗失误的急性胸、腰段脊柱脊髓损伤患者的临床资料和影像学资料进行分析,并根据临床具体情况进行外科处理。结果:104例患者中,残存腰痛45例次,脊柱畸形30例次,脊柱不稳35例次,脊髓神经受压8例次,坐位失平衡8例次。经再次手术治疗后脊柱畸形患者明显改善;椎管残存压迫的不完全性脊髓损伤患者椎管减压术后运动指数和感觉指数均增加;30例脊柱不稳定患者重建了脊柱稳定性;45例腰痛患者中40例腰痛消失或基本消失,5例仍有轻度腰痛需应用止痛药物,但不影响轮椅活动。结论:胸、腰段脊柱脊髓损伤手术治疗失误的主要因素包括手术适应证选择不当、手术技术失误和保守治疗不当。再处理方案主要参考首次治疗主要失误因素来确定。

Management of the patients of thoracic and lumbar spinal injuries with neurologic deficit after unsuccessful surgical treatment

Objecitve:To analyze the main factors for unsuccessful surgical treatment of thoracic and lumbar spinal injuries with neurologic deficit and to explore the treatment algorithm.Method:104patients with of tho-racic and lumbar spinal injuries with neurologic deficit who underwent unsuccessful surgical treatment were reviewed and re-operated based on the clinical materials.Result:Among the104cases,there were45cases with back pain,30with spinal deformity,35with spinal instability and38with canal encrochment,8cases had sitting inblance.After re-operation,there were marked decrease in gibbus angle in patients with spinal deformi-ty,motor score and sensory score increased in patients with imcomplete spinal cord injuries.30cases were re-stabilized in35cases with spinal instability.Also back pain was significant relieved in40patients with back pain,and other5cases could drive the wheelchiars with taking analgesic.Conclusion:The main factors for un-successful surgical management include inappropriate selection of surgical indications and inaccurate use of surgical technique.Treatment algorithm should be based on the main factors.