颈椎前路手术早期并发症的防治探讨

Study on prevention and treatment of the early complications in anterior cervical spine surgery

目的探讨颈椎前路手术早期并发症及其防治措施。方法回顾性分析该院2007年5月～2010年6月颈椎前路手术186例。其中颈椎病92例,颈椎间盘突出症59例,颈椎外伤32例,颈椎后纵韧带钙化3例,采用前路减压自体髂骨植骨融合带锁钢板内固定术95例,前路减压钛网植骨融合带锁钢板内固定术91例。结果术后随访3个月～1年,平均7个月20 d。手术相关并发症16例,发生率为8.5%,其中喉上、喉返神经损伤5例,脑脊液瘘3例,钢板螺钉松动、滑脱2例,颈部血肿2例,脊髓损伤加重1例,应激性溃疡2例,胸导管损伤1例。结论颈椎前路手术早期并发症原因较多,充分的术前准备,熟悉颈前路解剖,严格规范化操作以及良好的术后处理,是有效颈防和应对颈椎前路手术早期并发症的的关键。

[Objective] To analyze the complication related to anterior cervical spinal suegery and to explore the methods of prevention and management. [Methods] A retrospective analysis was performed on 186 cases treated with anterior cervical surgery. In the cases, 92 suffered from cervical spondylosis, 59 from cervical disc herniation, 32 from cervical trauma, 3 from calcification of the posterior longitudinal ligament in eervieal vertebrae. 95 cases treated with anterior cervical surgery were fused by autogenous iliae bones and anterior cervical spine locking plates, 91 cases with anterior cervical surgery were fused by titanium mesh cage and anterior cervical spine locking plates. [Results] All the cases were followed up for 3 monthes to 1 year with the average of 7 monthes and 20 days. 16 complications associated with surgery were found, with an incidence of 8.5%. Including superior laryngeal nerve injury and recurrent laryngeal nerve injury in 5, eere- brospinal fluid fistula in 3, complications related to internal fixation in 2, cervical haematoma in 2, aggravation of spine cord injury in 1, stress ulcer in 1, injury of thoracic duct in 1. [Conclusion] The complications of surgery on the anterior cervical spine are various. Adequate preoperative preparation, thorugh understanding of anatomy related to the anterior approach, skilled surgical technique and perfect postoperative management are essential for preventing the early complication in anterior cervical spine surgery.