经皮扩张气管切开术在重度颈髓损伤颈椎前路或前后路联合手术后人工气道中的应用

The Postoperative Application of Percutanous Dilatational Tracheostomy for Patients with Serious Cervical Spinal Cord Injury Undergoing Anterior or Combined Anterior-posterior Cervical Spine Fixation

目的探讨颈椎前路和颈椎前后路联合颈椎切开复位内固定手术后行经皮扩张气管切开术的安全性。方法回顾性分析2012年1月～2013年3月颈脊髓损伤17例,行颈前路(12例)或颈前后路(5例)切开复位内固定手术,术后5～11 d行经皮扩张气管切开术。结果 17例经皮扩张气管切开术均过程顺利,无颈前部重要器官损伤、术后局部大量出血、造瘘区域感染、颈前路手术切口及切口深层感染。结论颈前路手术5日后行经皮扩张气管切开术是安全高效的建立人工气道的方法。

Objective To investigate the feasibility of percutanous dilatational tracheostomy on patients undergoing anterior and anterior-posterior cervical spine fixation. Methods A retrospective analysis was done on 17 patients with cervical spinal cord injury who were admitted to ICU of Peking University Third Hospital from January 2012 to March 2013, including 12 cases of anterior and 5 cases of combined anterior-posterior cervical spine fixation. All patients received percutanous dilatational tracheostomy after anterior or anterior-posterior cervical spine fixation. The duration between the percutanous dilatational tracheostomy and the anterior/ anterior-posterior cervical spine fixation were 5 to 11 days. Results The procedure of percutanous dilatational tracheostomy was smooth in all 17 cases, with no intraoperative impairment to the vital organs, no postoperative heavy blood loss and no fistula infection. No concurrent anterior and anterior-posterior cervical incision infection occurred. Conclusions Percutanous dilatational tracheostomy is a safe and efficient way of building the artificial airway 5 days after the anterior and anterior-posterior cervical spine fixation.