脊髓型颈椎病前路手术并发症的临床分析

Clinical analysis of the postoperative complications of anterior approach surgery on cervical spondylotic myelopathy

目的分析脊髓型颈椎病前路手术的并发症及其原因,寻找防治对策。方法对96例脊髓型颈椎病患者采用前路减压植骨融合术,其中前路减压自体髂骨植骨融合16例,前路减压TFC椎间融合24例,前路减压自体髂骨植骨融合、前路锁定钢板固定56例。观察并分析术后并发症的发生情况。结果96例均获得随访,时间36～84(66±14)个月。发生并发症40例(51例次),发生率为41.7%。术后早期并发症包括:喉上神经损伤2例,硬膜破裂1例,植骨块移位1例,谵妄9例,C5神经麻痹6例,经过相应的对症处理均获得痊愈。远期并发症主要为邻近节段退变32例。4例出现新的神经症状和体征,其中2例再次行前路手术,术后症状有明显改善。结论颈椎前路手术伴有较高的并发症发生率,其原因是多方面的,均不同程度地影响着手术效果,尤其是邻近节段退变,临床应重视。

Objective To analysis the postoperative complications and the correlative factors of anterior approach surgery on cervical spondylotic myelopathy. Methods 96 cases of cervical spondylotic myelopathy received anterior approach surgery. Three kinds of surgeries were performed： anterior cervical decompression and autologous iliac bone interbody fusion （ 16 cases）, anterior cervical decompression and fusion with threaded fusion cage （24 cases）, anterior cervical decompression and autologous iliac bone fusion with anterior screw-plate system （56 cases）. Postoperative complications were recorded. Results The mean follow-up time was 66 ± 14 months （36 to 84 months）. The incident rate of postoperative complications was 41.7% （40/96）. Postoperative early complications included superior laryngeal nerve trauma in 2 cases, rupture of dora mater in 1 case, displacement of bone graft in 1 case, delirium in 9 cases, C5 palsy in 6 cases, which were cured through corresponding treatment. The long-term complications were degenerative changes adjacent to the fused segment in 32 cases, 4 of which occured neural signs and symptoms again. 2 of them received anterior cervical spine revision, and the outcomes were good. Conclusions The incident rate of the postoperative complications of anterior cervical spine surgery is high. The complications are resulted from multiple causes, which affects the operative effects, especially the degenerative changes adjacent to the fused segment.