胸腰椎结核前路手术的并发症及其防治

Prevention and treatment of complications of one stage surgical treatment of thoracolumbar spinal tuberculosis by anterior debridement with autograft bone fusion and spinal reconstuction

目的:探讨胸腰椎结核前路手术的并发症及其防治措施。方法:2000年2月-2006年12月我院采用一期前路病灶清除植骨内固定术治疗胸腰椎结核患者79例,其中男36例,女43例,年龄12-78岁,平均39.8岁。T4-T1028例,T11-L132例,L2-L419例。统计并发症发生的例数,分析其发生原因。结果:随访5-40个月,平均18.2个月。共12例(15.2%)发生并发症,术中并发症5例,其中淋巴管漏1例,肋间神经损伤4例;术后并发症7例,其中深静脉血栓形成1例,肺不张2例,结核复发2例,螺钉切割椎体进入椎间隙2例。原因多与术中操作不仔细或适应证掌握不当有关。结论:为降低脊柱结核前路手术的并发症,应严格掌握手术适应证,应熟悉解剖,术中仔细操作,提高手术技巧,彻底清除病灶,做好各项围手术期的处理。

Objective：To review and analyze the complications of tboracolumbor spinal tuborculosis by anterior debridement with autograft bone fusion and spinal reconstuction.Method：From February 2000 to December 2006,there were 79 patients with thoracic or lumbar tuberculosis were received anterior debridement with autograft bone fusion and spinal reconstruction in author＇s clinic,which included 36 male and 43 female.The average age was 39.8 years（range,12 to 78 years）.The lesion located at the T4-T10 level in 28 patients,T11-L1 in 32,L2-L4 in 19.The intraoperative and postoperative complications were analysed. Result：The average period of follow-up was 18.2 months （range,5 to 40 months ）.The complications could be divided into intraoperative complications and postoperative complications.Intraoperative complications included： chylous fistula（ 1 patient）,intercostal nerve injury（4 patients ）.Postoperative complications included ：deep venous thrombosis（1 patient）,pulmonary atelectasis（2 patients）,recurrence（2 patients）,screw cut-out from vertebrae（2 patients ）.The complications were all connected to the carelessness or the improper indications.Conclusion：In order to reduce the incidence of complications in surgical treatment of thoracolumbar spinal tuberculosis by anterior debridement with autograft bone fusion and spinal reconstuction,the indication,the anatomy,the surgical skill,the radical debridement and the appropriate perioperative management are all essential.