腰椎滑脱症固定融合手术并发症及其防治

Analysis of operative complications of spondylolisthesis

目的:探讨腰椎滑脱症内固定手术的并发症及其防治。方法:统计216例腰椎滑脱症患者行内固定手术的术中和术后并发症,分析发生原因并探讨预防措施。结果:216例患者中,术中并发症8例次,占3.7%,其中硬脊膜撕裂3例次,定位错误2例次,神经根与马尾神经损伤3例次;术后并发症24例次,占11.1%,其中脑脊液漏3例次,切口血肿2例次,椎间隙感染2例次,内固定失败5例次,植骨不愈合11例次,肺栓塞1例次。原因多与适应证掌握不严及术中操作不仔细有关。结论:腰椎滑脱症内固定手术并发症较多,严格掌握手术适应证,术中仔细操作,术后密切观察,积极预防和及时处理并发症。

Objective:To review and analyze the complications of spondylolisthesis treated with internal fixation.Method:216 patients with spondylolisthesis treated by decompression and posterolateral instrumentmented fusion were studied.The intraoperative and postoperative complications were reviewed.Result:The complications could be divided into intraoperative complications and postoperative complications.The intraoperative complication rate was 3.7%.There were dura tear 3 cases(1.4%), nerve root injury and cauda equine injury 3 cases(1.4%) and incorrect localization 2 cases(0.9%). The postoperative complication rate was 11.1%,which were incision hematoma 2 cases(0.9%),neurological deficits 2 cases(0.9%),pulmonary embolism 1 case(0.5%),implant failures 5 cases(2.3%), cerebralspinal fluid leakage 3 cases(1.4%) and pseudoarthrosis formation 11 cases(5.1%).Conclusion:The complications of spondylolisthesis with intermal fixation are severe and multiple,which can be abolished by right selection of surgical indications,proper manipulation,early diagnosis and prompt management correspondingly.