颈椎前路手术并发症的防治探讨

目的总结颈椎前路手术并发症,探讨其防治策略。方法回顾性分析我院1998年6月-2007年8月颈椎前路手术236例。其中颈椎病110例,颈椎间盘突出症56例,颈椎外伤67例,颈椎结核3例。采用前路减压自体髂骨植骨融合带锁钢板内固定术178例,前路减压钛网植骨融合带锁钢板内固定术56例,人工颈椎间盘置换术2例。结果术后随访3个月-2年,平均1年2个月。手术相关并发症25例,发生率为10.6%。其中喉上神经损伤2例,喉返神经损伤3例,脊髓损伤加重1例,脑脊液瘘3例,颈部血肿2例,植骨融合、内固定相关并发症3例,切口感染2例,肺部感染8例,应激性溃疡1例。结论颈椎前路手术可发生多种并发症,充分的术前准备,熟悉颈前路解剖,严格规范化操作以及良好的术后管理,是预防颈椎前路手术并发症的关键。

The study on prevention and treatment of complications in anterior cervical spine surgery

Objective To study the prevention and treatment of complications occurring in the anterior cervical spine surgery. Methods A retrospective analysis was performed on 236 cases treated with anterior cervical surgery. In these cases, 110 suffered from cervical spondylosis,56 from cervical disc herniation,67 from cervical tramna,3 from cervical tuberculosis. 178 cases treated with anterior cervical surgery were fused by autogenous iliac bones and anterior cervical spine locking plateds, 56 cases with anterior cervical surgery were fused by titanium mesh cage and anterior cervical spine locking plates and 2 cases with artificial cervical disc replacement. Results All the cases were followed up for 3 months to 2 years with the average of 1 year and 2 months. 25 complications associated with surgery were found ,with an incidence of 10. 6%. Including superior laryngeal nerve injuries in 2 ,recurrent laryngeal nerve injury in 3 ,aggravation of spine cord injury in 1 ,cerebrospinal fluid fistula in 3 ,cervical haematoma in 2, complications related to bone graft fusion and internal fixation in 3, incision infection in 2, pulmonary infection in 8, stress ulcer in 1. Conclusion Various complications may occur in the anterior cervical spine surgery. Adequate preoperative preparation, thorough understanding of anatomy related to the anterior approach, skilled surgical technique and perfect postoperative management are essential for preventing the complications in anterior cervical spine surgery.