上颈段伤患再次手术原因分析与对策

The reason and prevention of upper cervical reoperations

目的 分析 13例上颈段伤患再次手术的原因 ,探讨其防治对策。 方法 回顾性研究近年来所进行的 13例上颈段再次手术病例 ,对其再次手术的原因进行分析 ,探讨减少上颈段伤患手术并发症和不良后果 ,避免再次手术的措施。 结果 导致再次手术的原因有 :术后寰枢椎不稳或再次脱位 9例次 ,残留脊髓压迫 10例次 ,齿状突螺钉置入位置错误 1例次 ,手术邻近节段退变 1例次 ,枕颈植骨融合失败 1例次 ,术中脊髓损伤 1例次 ,后方植骨块滑入椎管 1例次 ,症状加重病人要求取出内固定 1例次。 结论 引起上颈段伤患再次手术的常见原因为术后寰枢椎不稳或再次脱位和残留脊髓压迫 ;减少手术操作失误 ,经口前路齿状突切除减压术时加行后路融合术 ,对陈旧性寰枢椎脱位采用坚强内固定 。

Objective To discuss the reasons for the operation performed on 13 patients with upper cervical disease and to explore the management and prevention of upper cervical disease. Methods Thirteen patients with upper cervical disease were retrospectively reviewed. The reason for of reoperations on these patients were analyzed. The measures to reduce upper cervical operational complication and bad prognosis were discussed to avoid reoperations. Results The reasons for reoperations included 9 cases with unstable or redislocated atlantoaxial joint, 10 cases with residual spinal cord compression, 1 case with malposition of odontoid screw, 1 case with adjacent cervical spine regression, 1 case with occipital cervical fusion failure, 1 case with spinal cord injury during operation, 1 case with bone plant sliped into canales spinalis, and 1 case with demand to take out internal fixation for aggravated symptom. Conclusions The common reasons for upper cervical reoperations were due to unstability or redislocation of atlantoaxial joint and residual of spinal cord compression. Some measures such as reducing operate miss, using firm internal fixation and decompressing were advisable to decrease the incidence of reoperations.