颈椎前路内固定手术并发症分析

Analysis of surgical complications in cervical anterior internal fixation

[目的]探讨颈椎前路内固定手术相关并发症发生原因,并提出对策和预防措施。[方法]回顾性分析自2003年1月～2011年12月本科行颈椎前路内固定手术并获随访患者共239例,其中男155例,女84例,年龄12～85岁。患病种类包括颈椎骨折脱位47例(19.67%),肿瘤6例(2.51%),颈椎结核3例(1.26%),颈椎病183例(76.56%)。对手术所发生的并发症进行总结分析。[结果]239例患者中发生术中和术后并发症共计12例(5.02%),男7例,女5例,内固定松脱或位置不佳共6例(包括外院2例),发生率2.51%;喉返神经损伤1例,发生率0.42%;肺部感染1例;血肿形成1例;食道瘘1例;脑脊液漏1例;泌尿系感染1例。内固定相关并发症及时翻修,均预后良好;术后发生食道瘘1例,及时发现后行修补术,清创后再行胃造瘘术,食道造影确认愈合后拔除造瘘管,患者恢复良好。术后发生喉返神经损伤患者1例经过激素、脱水等药物保守治疗,术后1个月内恢复至正常;1例患者术后脑脊液漏并囊肿形成,穿刺抽液联合抗生素保守治疗痊愈。[结论]颈椎前路内固定有其特殊性,术前充分准备,术中熟练规范操作,个体化评估和诊治是避免并发症发生的关键。

[ Objective ] To investigate the causes of complications of cervical anterior internal fixation, and put forward countermeasures and preventive measures. [ Method] We retrospectively studied 239 cases undergone cervical anterior internal fixation from January 2003 to December 2011 ,of whom 155 cases were male and 84 cases were female,with the age from 12 years to 85 years. The cases included cervical fracture or dislocation in 47 cases （ 19.67% ） ,tumors in 6 cases （2.51%） ,cervical tuberculosis in 3 cases （1.26%） ,cervical spondylosis in 183 cases（76.56% ）. Complications of surgery were analyzed. [ Result] Intraoperative and postoperative complications occurred in 12 cases,including 7 males and 5 females and the incidence was 6.27%. The complications included the anterior cervical fixation loosening in 6 cases （2.51% ）, which had good recovery after soeond revision,wound infection in 4（ 1.67% ） ,recurrent laryngeal nerve injury in 1 case（0.42% ） ,lung infection in 1, hematoma in 1, esophageal fistula in 1, cerebrospinal fluid leakage in 1, urinary tract infection in 1 case. With second detection, repair, debridement, and gastrostomy, esophagus fistula was confirmed by angiography, and the patient recovered well. Recurrent laryngeal nerve injury in 1 case recovered to normal after conservative treatment with methylprednisolone, dehydrating agent and other drugs within 1 month after the operation. One case had leakage of cerebrospinal fluid and cyst formation, recovered after puncture and conservative treatment with antibiotic. [ Conclusion ] Anterior cervical internal fixation has special features. Fully preparation, skilled and standardized procedure,individualized assessment and treatment are the keys to avoid complications.