颈椎前路手术后切口血肿的风险评估及对策

Risk assessment and management of postoperative incision hematomas of anterior cervical spine surgery

目的:观察行颈椎前路手术后切口血肿压迫的临床表现,评估其风险因素,以尽早采取预防措施。方法:对2012年1月—2013年6月行颈椎前路手术的226例患者,行前路颈椎体次全切除植骨融合术(ACCF)85例,行前路颈椎间盘切除植骨融合术(ACDF)119例,ACCF+ACDF+人工颈椎间盘置换术(ADR)22例,术后对颈部切口血肿的风险因素进行分析并采取相应对策。结果:在后两种手术方式中有10例患者在术毕关闭伤口时评估术中损伤大,创面渗血较多,在术后安置冲洗管,术后引流液性质清亮后改接负压引流管。226例中4例出现术后切口血肿,在床旁立即把伤口全层打开,畅通气道后,急诊行血肿清除术。所有患者均康复出院,无一例死亡。结论:颈部血肿是颈前路术后最严重的早期并发症之一,对患者采取的手术方式、患者的既往史、术后生命体征观察、呼吸道和切口的护理等因素的正确评估、严密观察并全过程采取积极有效对策,是减少血肿发生率的关键。

Objective： To analysis presentations of postoperative wound hematoma and evaluate related risk factors. Methods： Between January 2012 and June 2013,a total of 226 patients underwent anterior cervical surgery in our department. 85 patients underwent anterior cervical vertebral body subtotal resection and bone grafting fusion（ ACCF）,postoperative drainage tubes are adopted and all tubes were unblocked; 115 patients underwent anterior cervical discectomy and fusion（ ACDF） and22 patients received ACCF ＋ ACDF ＋ cervical artificial disc replacement（ ADR） procedure. To analyze the risk factors of postoperative incision hematomas and take proper management. Results： Ten patients of ACCF ＋ ACDF ＋ ADR team with more expansive intraoperative trauma placed a paravertebral washing tube,then converted to negative pressure drainage when the drawing was clear. 4 of 226 cases suffered postoperative wound hematoma,opened the wound with all layers at bedside and removed the hematoma. All patients had a good prognosis. NO death case was reported. Conclusion： Postoperative paravertebral wound hematoma is one of the worst early complications. Airway obstruction by wound hematoma was a life-threatening complication without appropriate management. To learned operation procedure and history by heart and evaluated postoperative vital signs with close nursing care. The key points of decreasing the incidence rate of postoperative wound hematoma is that close observation and earlier and effective management.