双通道内镜辅助下腰椎融合术的围手术期并发症及应对措施分析

Perioperative complications analysis and countermeasures of biportal endoscopic lumbar intervertebral fusion

目的:分析双通道内镜辅助下腰椎融合术(biportal endoscopic lumbar intervertebral fusion,BELIF)治疗腰椎退变性疾病的围手术期并发症的原因及介绍应对措施。方法:128例患者接受双通道镜下腰椎融合术并至少随访3个月,记录患者术前及术后3个月随访时的腰腿痛视觉模拟评分(visual analogue scale,VAS)评分及Oswestry功能障碍指数(Oswestry disability index,ODI)。统计所有患者的总手术时间,镜下操作时间。记录患者围手术期并发症,分析原因及处理对策。结果:平均随访6.8±2.5个月,腰痛VAS评分由术前6.35±0.58分改善至末次随访时的2.31±1.22分(P<0.05),ODI由术前(48.47±13.12)%改善至(15.22±9.55)%(P<0.05)。围手术期并发症总计15例(11.7%),其中硬膜撕裂4例,术中未做处理,2例出现脑脊液,留置引流管至术后第5天;神经根损伤2例,术后给予营养神经对症治疗;术后血肿3例,1例接受急诊手术清除血肿,2例给予营养神经治疗;1例出现术后短暂的感觉异常,2例术后出现皮下瘀斑,术后1~2周左右消失;镜下节段错误2例,1例及时发现,另1例L5/S1滑脱患者,术中误将L5侧隐窝判断为S1侧隐窝,切除部分L5侧隐窝及关节突关节后发现错误,未造成进一步的破坏;1例切口愈合不佳,反复换药3个月后愈合。结论:BELIF术式治疗腰椎退变性疾病临床疗效好,早期开展时存在一定的并发症,大多数是技术原因,术者需要熟悉腰椎的镜下解剖结构特点。

Objectives: To analyze the causes of perioperative complications of biportal endoscopic lumbar intervertebral fusion(BELIF) in the treatment of degenerative lumbar disease and introduce corresponding countermeasures. Methods: 128 patients underwent BELIF and were followed up for at least 3 months. The visual analogue scale(VAS) scores and Oswestry disability index(ODI) of low back pain were recorded before the operation and during the 3-month follow-up. The total operative time and the operative time under the microscope of all the patients were counted. The perioperative complications were recorded to analyze the causes and propose countermeasures. Results: The average follow-up period was 6.8±2.5 months. The VAS score for low back pain improved from the preoperative 6.35±0.58 to 2.31±1.22 at the final follow-up(P<0.05), and the ODI improved from(48.47±13.12)% before operation to(15.22±9.55)%(P<0.05). A total of 15 cases(11.7%) of perioperative complications occurred, including: 4 cases of dural tear, no treatment during operation, and 2were found with cerebrospinal fluid leakage, giving indwelling drainage tube until the postoperative day 5;2cases of nerve root injury, giving postoperative symptomatic treatment of nutritional nerve;3 cases of postoperative hematoma, and 1 received emergency surgery to remove the hematoma and 2 received nutritional nerve treatment;1 case had transient postoperative paresthesia and 2 cases had postoperative subcutaneous ecchymosis, which disappeared in 1-2 weeks after operation;2 cases of segmental error under microscope,with 1 case being noticed in time, and the other was a case of L5/S1 slippage, which during operation the L5 lateral recess was mistakenly judged as the S1 lateral recess, and error was noticed after partial resection of the L5 lateral recess and facet joint without causing any further damage;1 case of poor wound healing,which healed after 2 months of repeated dressing changes. Conclusions: The BELIF operation has a good clinical effect in the treatment of lumbar degenerative diseases, but there are certain complications in the early stage. Most complications are due to technical reasons, and the surgeon needs to be familiar with the anatomical features of the lumbar spine under the endoscope.