脊髓型颈椎病前路手术并发症的防治探讨

How to prevent and treat the complications of cervical spondylotic myelopathy by anterior surgical approach

目的探讨脊髓型颈椎病前路手术并发症的原因分析及防治方法。方法近5年来我科采用颈前路减压植骨钢板内固定治疗单或双节段脊髓型颈椎病162例。结果本组患者术后出现反应性脊髓水肿3例,脑脊液漏1例,食管漏1例,喉返神经损伤3例,肺部感染5例,其中1例因呼吸衰竭死亡。随访6个月～5年(平均3.5年),按JOA评分,术后12～16分,平均14.6分。结论充分的术前准备,熟悉颈前入路解剖,严格规范化手术操作及围手术期管理,可有效预防颈椎前路手术各种并发症的发生。

Objective To discuss how to prevent and treat the surgical complications of cervi- cal spondylotic myelopathy （CSM） by anterior surgical approach. Methods Anterior surgical ap- proach were applied in 162 cases for single or double GSM from 2006 to 2011. Results There were 18 complications after operation,as follows 3 cases with aggravated spinal cord injury,1 case with cerebrospinal fluid leakage,1 case with esophageal fistula,3 cases with recurrent laryngeal nerve injury,and 5 cases with pulmonary infection. All patients were followed up for six months to 5 years （average 3.5 years）. According to JOA criteria,the postoperative score were 12-16 （ average 14.6）. Conclusion Adequate preoperative preparation,thorough understanding of anatomy in the anterior cervical surgical approach,skilled surgical technique,strict perioperative management,can effectively prevent various complications in anterior cervical spine surgery.