脊柱结核合并神经损伤患者围术期评估及并发症防治策略

Perioperative Evaluation and Prevention of Complications for Spinal Tuberculosis Patients with Nerve Injury

目的探讨脊柱结核合并神经损伤患者围术期安全管理及并发症防治策略。方法回顾性分析2013年1月—2015年2月河北省胸科医院骨科收治的128例脊柱结核合并神经损伤病例资料。结果本组术前有内科合并症者88例,主要包括糖尿病、高血压病、冠心病、风湿免疫性疾病、肺结核等。128例均在全麻下行病灶清除减压植骨内固定术。术中发生神经损伤24例,胸膜损伤23例,腹膜损伤4例;术后出现低钾血症7例,心律失常、贫血及低蛋白血症各6例,心功能不全5例,切口感染及胸腔积液各3例,窦道形成2例,呼吸困难1例,均予对症处理后安全度过围术期。128例术后结核中毒症状均消失,下肢神经功能均有1~2级改善,脊柱后凸畸形均有不同程度改善,疼痛症状明显改善,1年后骨病灶全部愈合。结论脊柱结核合并神经损伤患者围术期并发症较多,积极的围术期评估和正确的处理是手术成功的重要保证。

Objective To investigate perioperative safety management and prevention of complications for spinal tuberculosis patients with nerve injury. Methods Clinical data of 128 spinal tuberculosis patients with nerve injury during Jan- uary 2013 and February 2015 was retrospectively analyzed. Results Among the patients, 88 patients had preoperative com- plications of internal medicine, which mainly included diabetes, hypertension, coronary heart disease, rheumatic diseases and tuberculosis. The 128 patients underwent lesion clearing, decompression and internal fixation under general anesthesia. There were 24 patients with nerve injury during the operation, 23 patients with pleural injury and 4 patients with peritoneal injury; there were 7 patients with hypokalemia, 6 patients with arrhythmia, 6 patients with anemia, 6 patients with hypoproteinemia, 5 patients with cardiac dysfunction, 3 patients with incision infection, 3 patients with pleural effusion, 2 patients with sinus formation and 1 patient with dyspnea after the operation, and all patients were safe during peroperative period by symptomatic treatment. Postoperative tuberculosis poisoning symptoms disappeared in the 128 patients, and nerve functions of lower limbs had 1-2 levels of improvement, and kyphosis was improved with different degrees, and pain symptoms were improved significantly, and bone lesions healed in all patients 1 year later. Conclusion Spinal tuberculosis patients with nerve injury have more perioperative complications, and therefore correct assessment and treatment are important to ensure the success of the operation.