颈椎病前路手术后术区血肿的处理

Treatment of hematomas in operation area after anterior approach surgery for cervical spondylosis

目的 探讨颈椎病前路手术后术区血肿的处理措施及预防策略. 方法 回顾性分析2007年1月-2013年7月收治的785例颈椎病前路手术患者的临床资料,术后出现术区血肿压迫12例,其中男10例,女2例；年龄40 ～71岁,平均56.8岁.手术方式均采用前路经颈椎体次全切除植骨融合内固定术（钛网＋钢板）,术中出血300～1 200 ml.5例术后出现呼吸困难,6例出现脊髓功能障碍,1例同时出现上述两种症状.10例发生于术后0.5～ 22 h,2例分别发生于术后73 h与74 h.12例均再次行颈椎前路探查术. 结果 硬膜外血肿5例,皮下血肿6例,同时存在皮下血肿和硬膜外血肿1例.经手术干预后呼吸状况及神经功能均得到好转,出院时呼吸状况无明显异常,神经功能优于术前.除1例出院后死于心血管相关疾病外,余11例随访时间6～43个月,平均19.8个月,末次随访时日本骨科学会（Japanese Orthopedic Association,JOA）评分均较术前提高. 结论 颈椎病前路手术后早期特别是24 h内是术后术区血肿的高发期,应密切注意患者呼吸及肢体感觉和运动情况.早期发现、早期手术干预是避免严重后果的主要对策.

Objective To investigate the treatment and prevention strategies of hematomas in op- eration area after anterior approach surgery for cervical spondylosis. Methods A retrospective review was conducted on 12 with hematoma compression in operation area out of 785 patients managed by anterior cervical surgery from January 2007 to July 2013, including 10 males and 2 females at age ranging from 40-71 years （mean 56.8 years）. Surgery method wasanterior cervical corpectomy and interbody fusion u- sing titanium mesh cage plus plate and intraoperative blood loss was 300 -1 200 ml. Primary clinical man- ifestations were neurological dysfunction in 5 patients, dyspnea in 6, and both neurological dysfunction and dyspnea in 1. There were 10 patients with the presence of symptoms at postoperative 0.5-22 hours, 1 at postoperative 73 hours, and 1 at postoperative 74 hours. All the 12 patients underwent a second anteri- or cervical exploration. Results There were 5 patients with epidural hematoma, 6 with subcutaneous hematoma, and 1 with both hematomas. After surgical interventions, the patients presented improvement in respiratory and neurological function, with inapparent respiratory abnormality and improved neurological function at discharge. One patient was died of cardiovascular-associated disease after being discharged from hospital. The left 11 patients were followed up for mean 19.8 months （range, 6-43 months）, with improved Japanese Orthopedic Association （JOA） score at final follow-up. Conclusions Hematoma took place frequently in the early period, especially within 24 hours in operation area after anterior ap- proach to cervical disorders and close attention should be paid to respiratory and limb sensation and mo- tion functions. Early detection and early surgical interventions are the key countermeasures to avoiding the severe results.