腰椎间盘突出症和椎管狭窄症手术并发症的回顾性分析

Retrospective analysis of operative complications of lumbar disc herniation and lumbar canal stenosis

目的回顾性分析腰椎间盘突出症和椎管狭窄症手术并发症发生的原因及对策。方法自1992年5月～2002年5月手术治疗腰椎间盘突出症和椎管狭窄症2560例,发生并发症134例,发生率为5.23%,其中腰椎间盘突出症的并发症发生率为3.75%,腰椎间盘突出症伴侧隐窝狭窄为4.70%,单纯侧隐窝狭窄为5.13%,腰椎间盘突出症伴中央椎管狭窄为8.97%,单纯中央椎管狭窄为7.93%。器械使用不当引起的并发症为67例,其中椎板咬骨钳所致53例,占79.1%。术后椎间盘炎8例,发生率0.3%。定位错误19例,发生率为0.74%。术后发生脑血栓2例、肺栓塞1例。2例L4全椎板切除术后发生继发性腰椎滑脱。3例硬脊膜撕裂者术后发生脑脊液囊肿。复发性腰椎间盘突出症26例。切口血肿致神经根性放射痛12例。结果19例定位错误者,其中15例术中纠正,4例再次手术。神经根损伤者18例,其中16例完全恢复。马尾神经损伤者4例均不完全恢复。右髂外动脉破裂者经及时探查、修补后康复。除肺栓塞者经抢救无效死亡外,其余并发症通过处理痊愈。结论要严格把好术前诊断、术中操作和术后处理关,以减少并发症的发生。

Objective To analyze retrospectively the causes of operative complications of lumbar disc herniation and lumbar canal stenosis as well as the treatment outcomes in order to reduce the surgical morbidities and to suggest preventive measures of complications.Methods The data of 2560cases with lum bar disc herniation and lumbar canal stenosis were reviewed from May1992to May2002.The total inci-dence rate of operative complications was5.23%.The incidence of surgical complications was3.75%in lum-bar disc hernia tion,4.70%in lumbar disc herniation combined with lateral recess stenosis,5.13%in lateral re-cess stenosis,8.97%in lumbar disc herniation combined with central stenosis,and7.93%in spinal cen tral stenosis.The complications were divided into intraoperative and postoperative groups.In the group of in tra-operative com plications,there were dural tear in38,mal-localization in19,nerve root injury in18,cau da e-quina in jury in4,and right external iliac artery disruption in1;in the group of postoperative complications,there were re currence of lumbar disc herniation in26,incisional hematoma in12,discitis in8,cere brospinal fluid cyst in3,acquired lumbar spondylolisthesis in2,cerebral infarction in2,and pulmonary em bolism in1.The com plications of 67cases were related with inappropriate usage of surgical instrument,53cases(79.1%)of whom were due to non-proper use with Kerrison rongeur,9cases with nerve dissector,2cases with nerve tractor and disc rongeur,and1case with periosteal elevator.Results In19cases with mal-localization prior to operation,15were corrected immediately during operation,the other4had to have second operation.In18cases complicating with nerve root injury,16had complete recovery,4cases with cauda equina injury had only incomplete recovery.The patient complicated with right external iliac artery disruption was recovered through prompt exploration and repairing.All patients with surgical complications were fully recovered by proper treatment except one died of pulmonary embolism.Conclusion If sufficient preven tive measures are applied in perioperative period,surgical complications may be reduced and managed effectively.