腰椎间盘突出症手术并发症和失误的防治

Prevention and Treatment of Complications and Errors in Lumbar Discectomy

本文报告腰椎间盘突出症手术并发症６９例，其中包括髂血管破裂２例，严重化脓性感染５例，椎间隙感染８例，神经根或马尾神经撕裂５例，马尾综合征３例，硬膜或神经根周围瘢痕粘连７例，侧隐窝或神经根管狭窄６例，椎管狭窄２例，原间隙再突出７例，其它间隙突出５例，脑脊液漏引起腰骶部大囊肿２例，定位错误１２例，诊断错误５例。上述并发症中死亡２例。本院发生的占２５例，为本院同期手术病例的２４％。外院占４４例。随访半年～１５年，平均２年１个月。对其所发生的原因、诊断、预防和治疗作了讨论。手术医生要有正确诊断和处理该并发症的准备和能力。用钆（ｇ－ＤＴＰＡ）造影增强ＭＲＩ检查对鉴别术后椎间盘是否再突出还是瘢痕粘连比用ＣＴＭ和脊髓造影更好。对可疑马尾综合征的病例要紧急作ＭＲＩ或脊髓造影。

This paper reported the complications and errors of the discectomy in 69 patients including the iliac vessels injury in 2,severe wound infection in 5,intervertebral discitis in 8,nerve root or cauda equina injury in 5,cauda equina syndrome in 3,epidural or around nerve root fibrosis in 7,lateral recess or nerve root canal narrow in 6,spinal canal stenosis in 2,recurrent disc hernia at same level in 7and at other level in 5,cyst at lumbosacral caused by cerebrospinal fluid fistula in 2,level mistake in 12,and misdiagnosis in 5 cases.Two patients died from above complications.Among the 69 patients,25cases was happened in authors hospital and the rate of complications was 1 7%(25 of 1050patients).The causes,diagnosis,prevention and treatment of these problems were discussed in detail.The surgeon must be prepared to identify each of these problems and deal with them as quickly as possible.MRI enhancement technique with G DTPA was more helpful than CTM and myelography to distinguish between recurrent disc herniation and postoperative fibrosis.Once the cauda equina syndrome was suspected,a myelogram or MRI should be done immediately.If there was any evidence of extradural compression on the neural elements,reexploration should be done quickly.