医源性脊髓神经损伤的预防与治疗

Prevention and treatment of iatrogenic injury of spinal nerves

目的:分析和探讨医源性脊髓神经损伤的发生原因、损伤机制和临床特点以及神经损伤的预防和治疗.方法:回顾性分析5 800例脊柱外科手术中发生医源性脊髓神经损伤52例的诊断治疗.52例神经损伤中,术前椎管造影3例(椎管内肿瘤造影剂注入量大),术前不适当牵引及搬动2例(脊柱骨折),手术损伤38例(手术器械直接损伤,神经牵拉伤),术后并发症9例(术后血肿压迫).结果:随访10～34个月,平均14个月.24例脊髓损伤恢复情况,按ASIA分级:A级4例,B级3例,C级4例,D级5例,E级8例.28例神经根损伤18例完全恢复,10例残留不同程度感觉、运动障碍.结论:医源性脊髓神经损伤发生主要跟医生的责任心、临床经验、手术时精力集中程度有关,同时病情的特殊性、复杂性也增加了神经损伤的发生率.

Objective: To investigate the reasons and mechanism and clinical characteristicses of iatrogenic spinal nerves injury for the sake of the solution,prevention and the treatment of the nerve injury.Method: A total of 5 800 cases were operated on spinal cord,52 cases injured of spinal nerves were analyzed retrospectively,3 cases had injured intraspinal canal myelography,2 cases had injured for bad-movement preoperation,38 cases had injured by operation,9 cases had injured from complication of operation.Result: Fifty-two cases were followed-up for 10~34 months,averaged 14 months,24 cases of spinal cords injures recovered according to ratings of ASIA:4 cases of A class,3 cases of B class,4 cases of C class,5 cases of D class,8 cases of E class.28 cases of spinal nerve root injuries:18 cases recovered,10 cases had a degree obstruction of sensation and movement.Conclusion:The causes of iatrogenic spinal nerve injuries are mainly due to the doctor's responsibility,clinical experience,surgical operation energy concentration degree and the special,complexity of the disease condition also increases the nerve at the same time the occurrence rate of the harm.