颈椎前路手术的并发症

Preventionand management of complications in anterior cervical spine surgery

【目的总结分析颈椎前路手术并发症,探索其防治策略。方法自1995～2002年共行颈椎前路手术3163例,术后出现各种手术并发症646例。术后获随访1848例,随访期6个月～8年,平均2年3个月。减压方式有环锯减压、椎体次全切除、椎间盘切除和病灶清除;植骨方式有自体髂骨植骨、BAK植骨、方盒形Cage植骨以及钛网植骨等;部分患者采用颈椎前路带锁钢板固定。结果喉返神经或喉上神经损伤26例,4～12周后基本恢复正常。术后颈部血肿16例,术中止血不彻底和术后引流不畅是其主要原因。颈脊髓或神经根刺激、损伤13例,经脱水治疗多数恢复满意。脑脊液漏11例,经颈部制动和切口局部适度加压后愈合。切口感染8例,经抗感染、清创缝合等治疗后愈合。食管瘘2例,经修补术治愈。植骨块移位8例,均于发生后当天或第2d再次手术。植骨不愈合假关节形成17例,均行翻修手术。相邻节段退变35例,6例因出现新的脊髓压迫症状再次行颈前路减压术,术后症状缓解。髂骨供区并发症342例,主要表现为局部疼痛和股外侧皮神经损伤症状。内植物相关并发症中,BAK下沉10例,钢板断裂1例,钢板螺钉脱落1例,钛网下端下沉7例。颈部轴性疼痛216例。猝死1例。结论颈椎前路手术可发生多种并发症,程序化、标准化的诊治方案是减少颈椎前路手术并发症的关键。

Objective To study the prevention and treatment of complications occurring in anterior cervical spinal surgery.Methods3163cases with cervical spondylotic meylopathy,spinal injury,spinal tu-mor and spinal tuberculosis treated by anterior cervical surgery,were included in this study.Trephination,corpectomy,disectomy and debridement were used for decompression,iliac bone autograft,BAK cage,cubic shaped cages and titanium mesh cages were used for bone grafting,while anterior cervical spine locking plates were performed in some of the cases.1848cases were followed-up from6months to8years with an aver-age of 2years and3months.646cases suffered from operative complications,372cases were immediate due to anterior cervical surgery,and the incidence of morbidity was11.76%.Results26cases of transient laryn-geal nerve or superior laryngeal nerve injury recovered in4to12weeks without special treatment.Most of 16cases with cervical hemotoma were caused by bleeding of smaller blood vessels and obstruction of drainage.13cases of spinal cord or nerve root irritation or injury were treated with medicine for dehydration,12of them had good result.11cases of CSF leakage were cured with cervical spinal immobilization and moderate local compression.8cases of local infection were cured with antibiotics or combined with debride-ment and suturing.2cases of esophagus perforation were repaired and healed.8cases of grafted bone dis-placement were re-operated on the day or second day of occurring.17cases of pseudoarthritis had revision surgery.6of 35cases of adjacent segments degeneration with new symptoms of spinal cord compression were treated with anterior cervical decompression again,and had good results.Most of 342cases of iliac donor side com plications were local pain or lateral femoral cutaneous nerve injury,infection occurred in some cases.Compli cations related to instruments included10cases of BAK subsidence,1case of plate breakage,1case of screws and plate back-out and7cases of titanium mesh cage subsidence.216cases of cervical axial pain were cured3to6months later with medicine.There was1case of sudden death in this group.Conclusion Many kinds of operative complications could occur in anterior cervical surgery.A standardized procedure in diagnosis and surgery methods are the key points to decrease and prevent operative related complications.