颈椎前路手术并发症及应对措施

Prevention and management of complications associated with anterior cervical spinal surgery

目的 总结分析颈椎前路手术并发症，探讨其防治策略。方法 收集1998年7月～2005年6月颈椎前路手术252例，出现手术相关并发症27例次，发生率为10．7％。减压方式包括间盘切除、环锯减压和椎体次全切除。植骨融合方式包括自体髂骨植骨、Cage植骨和钛网植骨。部分患者采用钢板内固定。结果喉返或喉上神经损伤7例，除1例喉返神经损伤症状未恢复外，其余均在1～4周内恢复。脑脊液漏2例，2周后切口愈合。内植物并发症5例，包括螺钉位置不良、松动和脱出等。植骨块部分滑出3例，均发生在单纯髂骨植骨患者，经严格制动后未继续滑出并融合满意。颈脊髓和神经根损伤各1例，经脱水和激素等治疗后恢复满意。颈部切口血肿、感染4例，经清创和抗感染后愈合。髂骨供骨区并发症4例，主要为血肿感染和股外侧皮神经损伤等。迟发性食管瘘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，提高手术技能，术后密切随访，可减少或避免并发症的发生。

Objective To study the prevention and management of complications associated with anterior cervical spinal surgery. Methods Included in the study were 252 cases of anterior cervical spinal surgery performed from July 1998 to June 2005. Twenty- seven complications associated with the surgery occurred,with an incidence of 10.7%. Discectomy,trephination and corpectomy were used for decompression. Bone grafting consisted of autogenous iliac bone, cage and titanium mesh cage. Internal fixation with plate was also performed in some patients. Results Six of the 7 complications of recurrent laryngeal nerve or superior laryngeal nerve injuries re-covered fully in 1- 4 weeks postoperatively. CSF leakage of 2 cases were cured after two - week conservative management. Implant failure occurred in 5 cases, including malposition, loosening or pullout of screws. Partial dislodgement of iliac autograft bone was noted in 3 cases without internal fixation. The bonegraft did not slip further after strict immobilization with solid fusion obtained. Both 1 spinal cord injury and 1 nerve root injury were treated with methylprednisolone and medicine for dehydration. Four cases of wound infection healed after debridement and antibiotics administration. Four complications related to the iliac bone donor site presented as wound infections and lateral femoral cutaneous nerve injury. Delayed esophagus fistula was found in 1 outpatient. Conclusion Many kinds of complications could occur in preparation, deep understanding of anatomy related to the postoperative follow- up are the keys to prevent or aviod anterior cervical spinal surgery. Adequate preoperative anterior approach, skilled surgical technique and close the occurrence of these complications.