颈前路手术早期并发症的防治

PREVENTION AND TREATMENT OF EARLY POSTOPERATIVE COMPLICATIONS OF ANTERIOR CERVICAL SPINAL SURGERY

目的总结分析颈椎前路手术早期并发症,探讨其防治策略。方法1998年11月-2006年12月,采用前路手术治疗颈椎疾患363例,其中男268例,女95例;年龄17～79岁,中位年龄50.6岁。颈椎病224例,颈椎间盘突出症39例,颈椎外伤87例,颈椎肿瘤9例,颈椎结核4例。采用前路减压、自体髂骨融合治疗48例,前路减压、植骨融合联合带锁钢板内固定132例,前路减压、钛网植入联合带锁钢板内固定183例。结果术后282例获随访3个月～5年,平均1年11个月。手术相关并发症23例,发生率为8.16%。喉上神经损伤3例,经禁流质饮食及补液治疗,术后3～7d症状消失;喉返神经损伤2例,行发音训练,3个月后恢复正常;脊髓损伤1例,经抗炎脱水治疗,下肢肌力6个月后恢复至术前水平;硬脊膜撕裂2例,经皮肤肌肉严密缝合,切口适度加压包扎后愈合;内固定相关并发症10例,其中1例螺钉拔出,因吞咽困难行再次手术,余行对症治疗、头颈胸石膏固定,3～18个月后固定节段融合;颈部血肿形成4例,其中1例因抢救方法不当死亡;植骨区及创口感染1例。结论充分的术前准备、熟悉颈前路解剖以及严格规范化操作,是预防颈椎前路手术早期并发症的关键。

Objective To study the prevention and management of early complications associated with anterior cervical spinal surgery. Methods From November 1998 to December 2006, 363 cases were treated with anterior cervical surgery, including 268 males and 95 females aged 17-79 years. In these cases, 224 suffered from cervical spondylosis, 39 from cervical disc herniation, 87 from cervical trauma, 9 from cervical tumor and 4 from cervical tuberculosis. Forty-eight cases with anterior cervical surgery were fused by autogenous iliac bones, 132 cases with anterior cervical surgery were fused by autogenous iliac bones and anterior cervical spine locking plates, and 183 cases with anterior cervical surgery were fused by titanium mesh cage and anterior cervical spine locking plates. Results A total of 282 cases were followed up for 3 months to 5 years with the average of 1 year and 11 months. Twenty-three complications associated with surgery were found, with an incidence of 8.16%. Three cases of transient superior laryngeal nerve palsy recovered within 3-7 days after the restriction of liquid diet and fluid replacement. Two cases of recurrent laryngeal nerve palsy recovered by 3-month pronunciation practice. One case of spinal cord injury was treated with medicine for dehydration and anti-inflammation, and was restored to preoperative muscle power of inferior extremity after 6 months. Two cases of CSF leakage were cured with moderate local compression and meticulous water-tight wound closure. Among the 10 patients with complications of internal fixation, one suffering mild dysphagia was reoperated, while the others were treated with cephal-cervico-thorax plaster external fixation and recovered with solid fusion within 3-18 months. Among the 4 cases with cervical hematoma, 1 died of wrong rescue procedures and 1 was infected. Conclusion Adequate preoperative preparation, thorough understanding of anatomy related to the anterior approach and skilled surgical technique are essential for preventing the early postoperative complications of anterior cervical spinal surgery.