颈椎前路手术早期并发症

The complications of surgery on the anterior cervical spine

目的:分析总结颈椎前路手术早期并发症的原因,探索防范策略和治疗措施。方法:总结1999年7月～2003年7月在本院接受颈椎前路手术的412例患者的临床资料。手术方式:环锯椎体次全切除减压、椎间盘切除减压、肿瘤椎体切除、病灶清除、齿状突骨折复位螺钉内固定、下颈椎骨折脱位复位内固定;植骨方式:大块自体髂骨植骨、髂骨块椎间植骨、PEEKCage椎间融合器髂骨植骨融合、钛网髂骨植骨融合;多数患者采用前路钛板固定。术后328例出现早期并发症。结果:276例出现术后咽喉部刺激症状,是最多见的并发症,预后好;62例出现低钠血症,常发生在一般情况较差的老年患者和严重颈椎创伤的患者,病情顽固,纠正困难;10例脑脊液漏;8例喉返神经损伤皆为一过性,术中可以即刻出现,是最早出现的并发症;4例死亡,瘫痪加重7例,此二者是最严重的并发症;5例刀口内血肿;2例髂骨取骨处刀口脂肪液化;2例刀口感染;1例食道瘘。植入物并发症2例,钛板螺钉打入椎间隙。3例行早期翻修手术。结论:颈椎前路手术并发症较多,咽喉部刺激症状被忽视,此种并发症相当多见,但痊愈快,预后好。多数并发症可以治愈,部分可导致严重后果甚至死亡,围手术期严格管理和手术规范化是减少并发症的关键。

Objective:To analysis the complications of anterior cervical surgery and the treatment.Method:From July 1999 to July 2003,412 cases accepted the cervical surgery through anterior approach,including 205 cases of CSM,63 cases of radiculopathy,17 cases of CDH,104 cases of cervical injury,3 cases of dens fracture and 16 cases of cervical tumor.There were 293 males and 119 females,and the age ranged from 23~75,mean 53.2 years.Result:There were laryngeal and pharyngeal stimulation in 276 cases,hyponatremia in 62 cases,leakage of cerebrospinal fluid in 10 cases,recurrent nerve injury in 8 cases,death in 4 cases,exacerbation of pre-existing deficits in 7 cases,wound hematoma in 5 cases,fat liquifaction of the iliac wound in 2 cases,wound infection in 2 cases,esophogocutaneous fistula in 1 case,implant complication in 2 cases.Conclusion:The complications of surgery on the anterior cervical spine are various,and laryngeal and pharyngeal stimulation is the most common,but ignored easily.Most of them can be cured,part of them can result in serious consequence,or even death.The key of the control of the complications is the strict paraoperative management and the canonical operation.