经皮上颈椎螺钉内固定手术的并发症及其防范措施

Complications of percutaneous atlantoaxial screw fixation

近十年来我国脊柱微创外科有了快速的发展,取得了令人瞩目的成绩。在目前广泛开展微创技术的形势下,我们必须充分认识微创外科的两重性,即在了解微创外科优点的同时,也要知道微创外科的局限性及其可能发生的并发症和潜在风险。这样我们在工作中才能正确掌握其适应证,充分发挥微创外科的优势,设法克服或避免其存在的不足。为此,本期特邀请了几位脊柱微创外科专家就"脊柱微创手术并发症"问题作一讨论,供同道们参考,并诚挚欢迎同道们参与讨论。

Objective ： ：To summarize the incidence rate and causes of complications related to the surgery of pereutaneous atlantoaxial screw fixation.Method：The data of 87 cases treated in our hospital between March 2001 and May 2006 and followed up at least 18 months was retrospectively analysed,including three groups of percutaneous anterior odontoid screw fixation in 43 cases,pereutaneous anterior atlantoaxial transarticular screw fixation in 36 cases,and percutaneous posterior atlantoaxial transarticular screw fixation in 8 cases.The type and rate of complications were summarized.Result：Among 87 cases,20 cases had encountered complications. （1）The rate of complications related to screw fixation was about 19.5% in three groups and the total cases was 17.The screw tail was detained at the superior margin of C3 vertebral body in 8 cases and no one had symptom,so no additional treatment needed;screw malposition in 6 cases,4 of them had no symptom without additional treatment,and the other 2 cases underwent re-operation;displacement of fracture site in 2 cases,and one was treated by posterior fusion,one slight displacement was treated by solid orthosis for three months,and all received bony union;screw loosening in 1 case and was treated conservatively.The screw was pullod out after solid fusion one year later.4 cases（4.6%） needed a second operation.（2）The rate of complications not relatod to screw fixation was 3.5% and the total cases was 3.Temporary paralysis of superior laryngeal nerve due to the puncture happened in 1 case and was cured with medication.There were two infection cases,one incision infection and one pulmonary infection,they were all cured with effective anti-infective therapy.No other important nerve or vessel injury was found.Conclnsion：The majority of complications related to the surgery of percutaneous atlantoaxial screw fixation are mild,for which the special handling is unnecessary, the rate of severe and re-operated cases is quite low.