颈椎后纵韧带骨化症手术并发症探讨

Study of operative complications of ossification of posterior longitudinal ligament

[目的]探讨颈椎后纵韧带骨化症（OPLL）手术主要并发症的原因及对策。[方法]对2002年3月~2006年5月85例颈椎后纵韧带骨化症手术治疗病例进行回顾性分析。其中连续长节段骨化行颈后路全椎板切除减压内固定68例,发生并发症13例;孤立型或短节段骨化行颈前路椎体次全切减压植骨内固定17例,发生并发症3例。[结果]术后获得随访66例,随访期3~25个月,平均13个月。颈后路并发症：颈肩痛8例,给予消炎止痛药、脱水、理疗等保守治疗,术后2~20周患者疼痛缓解,恢复基本满意,其主要原因与减压后脊髓漂移神经根受牵拉或手术操作导致神经根受刺激或损伤有关。2周内缓解者可能与手术创伤局部组织水肿肌肉痉挛所致。术后不全瘫或症状加重4例,经药物及高压氧等治疗,3例恢复理想,1例恢复欠佳,不全瘫发生主要与手术减压后脊髓再灌注损伤有关。术后血肿2例,均经及时发现即刻手术探查血肿清除、激素冲击治疗而获得恢复,术中止血不彻底或手术创面渗血、引流管引流失败是其主要原因。脑脊液漏1例,经脱水、局部适当包扎及颈部制动,于术后3d脑脊液漏停止,切口愈合良好。手术切口感染2例,经抗感染、局部清创缝合等治疗术后20d左右获得愈合。前路并发症：术后不全瘫2例,经甲强龙冲击,神经营养药（弥可保）、高压氧治疗,术后20~30d完全恢复;脑脊液漏1例。内置物相关并发症：前路钛网下沉1例,后路内固定螺钉脱落1例（单枚）。[结论]颈椎后纵韧带骨化无论行后路或前路手术可发生多种并发症,有些是难以避免的,而有些则是可以经过努力预防或杜绝的,术前准备充分,术中小心操作,术后加强管理,是减少后纵韧带骨化手术并发症的关键。

[ Objective] To Probe the causes of significant operatiive complications of ossification of posterior longitudinal ligament as well as the treatment outcomes in order to reduce the surgical morbidities and to suggest preventive measures of complications. [ Method ] The surgical data of 85 cases with ossification of posterior longitudinal ligament were reviewed form March 2002 to May 2006. In continuous long segment OPLL which were treated by bilaminectomy with internal fixation system; short segment OPLL which were treated by corpectomy of anterior cervical approach with bone of autograft and anterior cervical spine locking plates. [ Result] Totally 66 cases were followed-up from 3 to 25 months with an average of 13 months. Complication of posteior cervical approach： 8 cases with the pain of neck-shoulder, which resulted from postoperative radiculopathy and nerve root irritation or injury. Most of 8 cases were recovered in 2 to 20 weeks by conservative treatment such as antalgica, dehydration and physiotherapy. Four cases with quadriparesis or symptom deteriorate, which resulted from reperfusion injury of spine cord. Two cases were recovered by hyperbaric oxygen and medication and 1 cases recovered not enough. Two cases with posterior cervical hemotoma were caused by bleeding of smaller blood vessels and obstruction of drainage. One case of CSF leakage were cured in 3 days with cervical spinal immobilization and moderate local compressiom. Two cases of local infection were cured during 20 days with antibiotics or combined with debridement and suturing. Complications of anterior cervical approach： a cases with quadriparesis or symptom deteriorate; 1 case of CSF leakage. Complications related to instruments included 1 case of titanium net subsidence and 1 case of single lateral mass screw back-out. [ Conclusion] Many kinds of operative complications could occur in either anterior or posterior approach of surgery of ossification of posterior longitudinal liga-menL Preoperative good preparation, intraoperative carefull operation and postoperative strengthened management are the key points to decrease and prevent operative related complications.