人工腰椎间盘置换术的并发症及其防治

Prevention and treatment of primary complications of artificial lumbar intervertebral disc replacement

目的:探讨人工腰椎间盘置换术并发症的原因及防治方法.方法:1999年12月～2001年11月间,应用Link(r)SB ChariteⅢ型人工椎间盘假体对30例患者的33个椎间盘进行了置换术,男16例,女14例;年龄36～54岁,平均44岁.腰椎间盘突出症22例,腰椎间盘切除术后失败6例,腰椎间盘退行性变2例.统计并发症发生的例数,分析其发生原因并探讨预防处理方法.结果:随访4个月～2年3个月,平均16.7个月.共发生7例20例次并发症,术中并发症包括腹膜撕裂3例次,椎前静脉出血1例次,椎体后上缘骨折1例次,假体位置不良4例次;术后并发症包括切口裂开1例次,腹膜后血肿1例次,腹壁切口疝1例次,6个椎间盘假体无运动,关节突关节自发性骨融合1例次,术后16个月椎弓根断裂1例次.结论:人工椎间盘置换术虽可保留手术节段的运动功能,但存在其特有的并发症,应严格手术适应证、掌握手术操作原则及技术并完善围手术期处理,减少并发症的发生.

Objective:To explore the cause of the complications of artificial lumbar intervertebral disc replacement and summarize the experience in the treatment and prevention.Method:From December 1999 to November 2001,30 patients underwent artificial lumbar intervertebral disc replacement with 33 Link(r)SB CharitéⅢ disc protheses.16 patients were men and 14 women.The average age was 44 years(range,36 to 54 years).Preoperative diagnosis included lumbar intervertebral disc heniation(22 patients),failed disc excision(6 patients) and lumbar disc degeneration(2 patients).The total number and type of all complications were recorded,and its cause,prevention and treatment were analyzed.Result:The average period of follow-up was 16.7 months(range,4 to 27 months).Complications occurred in 7 patients.Complications in operative period included:peritoneal rupture(3 patients),prevertebral vein hemorrhage (1 patient),fracture of the posteriosuperior edge of vertebral body(1 patient),malposition of prothesis(4 patients),postoperative complications included:incision rupture(1 patient),postperitoneal hematoma(1 patient),incision herniation(1 patient),no functions of the operated joint(4 patients) and spontaneous fusion of intervertebral joint(1 patient).One patient suffered from the fracture of pedicle at the operated level 16 months after operation.Conclusion:Although artificial lumbar intervertebral disc replacement can retain the functions of the operated joint,it has its special complications.However once obey operation principle with proficient operative technique,control surgical indication strictly and intensify perioperative treatment,the complications of artificial lumbar intervertebral disc replacement will be decreased consequently.