老年脊柱结核手术并发症的原因分析及处理

Cause and Treatment of Postoperative Complications in Elderly Patients with Spinal Tuberculosis

目的探讨老年脊柱结核手术并发症的发生原因及处理方法。方法回顾性分析2009年7月-2016年7月我院骨科行手术治疗的67例老年脊柱结核患者的病历资料，其中男38例，女29例；年龄65-83岁，平均（73．8±8．5）岁。颈椎结核2例，胸椎结核26例，胸腰段结核19例，腰椎结核17例，腰骶段结核3例。累及单个椎体1例，累及2个椎体49例，累及3个及3个以上椎体17例。31例患者采用前路手术，33例采用后路手术，3例采用前后路联合手术。结果随访时问为6-24个月，平均随访时间为（12．2±5．6）个月。17例患者共出现21例次并发症，其中胸膜破裂3例，硬膜曩撕裂1例，应激性溃疡3例，应激性精神障碍3例，下肢深静脉栓塞1例，胸腔积液2例，感染6例，结核复发1例，内固定松动1例。结论老年脊柱结核术后并发症发生率高，通过完善的术前准备，细致的手术操作可以降低手术并发症的发生率，积极有效的处理措施可以减少手术并发症的危害。

Objective To explore the cause and treatment of postoperative complications in elderly patients with spinal tu- berculosis. Methods 67 elderly patients with spinal tuberculosis who underwent surgical treatment from July 2009 to July 2016 in or- thopedics department of our hospital were retrospectively analyzed. There were 38 males and 29 females with a mean age of 73.8 years （range, 65 to 83 years）. There were 2 cases with cervical tuberculosis, 26 cases with thoracic tuberculosis, 19 cases with thoraco- lumbar tuberculosis, 17 cases with lumbar tuberculosis, and 3 cases with lumbosacral tuberculosis. Single vertebral body was in- volved in 1 case, 2 vertebral bodies were involved in 49 cases and more than 2 vertebral bodies were involved in 17 cases. Single an- terior approach was performed in 31 cases. Single posterior approach was performed in 33 cases. Anterior - posterior surgical approach was performed in 3 cases. Results The patients were followed - up and the duration ranged from 6 to 24 months, with an average of 12.2 months. 21 postoperative complications occurred in 17 patients, including pleural rupture in 3 cases, tearing of dural sac in 1 cases, stress ulcer in 3 cases, stress mental disorder in 3 cases, deep venous thrombosis in 1 case, pleural effusion in 2 cases, in- fection in 6 cases, recurrence of spinal tuberculosis in 1 case and loosening of internal fixation in 1 case. Conclusion The incidence of postoperative complications is high in elderly patients with spinal tuberculosis. Perfect preoperative preparation and meticulous oper- ation may reduce the incidence of complications.