摘要
目的探讨胸椎管狭窄症术后并发症的发生与防治。方法1985年1月至2005年1月手术治疗283例胸椎管狭窄症患者。胸椎黄韧带骨化症123例、胸椎后纵韧带骨化症73例、胸椎间盘突出症54例、弥漫性原发性骨肥厚症19例、椎体后缘骨内软骨结节14例。1996年以前均采用后入路，枪式咬骨钳切除椎板，咬除骨化的黄韧带或关节突的内1／2，为原始方法；1996年后，椎间盘突出或合并后纵韧带骨化、椎体后缘骨内软骨结节者采用经胸腔入路。黄韧带骨化、弥漫性原发性骨肥厚，采用后入路，应用磨钻加“揭盖法”切除椎板，在神经剥离子的保护下，应用骨凿切除关节突的内1／2，为改进方法。分别观察两组围手术期、中远期和供骨区并发症发生情况，并进行对比。结果随访254例，随访时间1—19年，平均6年2个月。并发症发生率42．1％，原始方法（65．2％）明显高于改进方法（23．2％）。各种并发症中脊髓损伤和硬脊膜损伤的发生率两组差异有统计学意义（P〈0．05）。结论脊髓损伤导致症状加重是灾难性的并发症。采用改进方法手术治疗胸椎管狭窄症可减少并发症的发生。
Objective To investigate the occurrence, prevention and management of surgical complications of thoracic spinal stenosis. Methods 283 patients with thoracic spinal stenosis from January 1985 to January 2005 were retrospectively analyzed. 123 patients ossificated at the yellow ligament of thoracic vertebra, 73 patients at posterior longitudinal ligament of thoracic vertebra. 54 patients suffered intervertebral disc herniation of thoracic vertebra, 19 patients with primarily diffuse hyperostosis, 14 patients with cartilage nodus of vertebral body posterior border. Before 1996, all the patients were operated from posterior approach, lamina was removed by rongeur, then ossific flavum ligaments and half of inner articular process were removed. After 1996, all patients with intervertebral disc herniation of thoracic vertebra or combined with ossification of posterior longitudinal ligament or cartilage nodus of vertebral body posterior border were operated from anterolateral thoracic cavity. Ossification of the yellow ligament and diffuse hyperostosis were operated from posterior. Vertebral Lamina were removed by drill and uncover method. Under the protection of nerve dissector, half of inner articular process was removed by osteotome. This was recorded as improved method. Results 254 cases were followed up. The follow-up duration was from 1 year to 19 years, with average 6 years and 2 months. Complications rate was 42.1%. 11 cases suffered with pulmonary infection, 7 cases with temporary nerve root injury, 3 cases with injury of lungs, 1 case with intra-spinal haematoma and these complications were cured. 13 cases with spinal cord injury after surgery were treated by mannitol and dexamethasone, while 8 cases recovered to preoperative condition and 5 cases aggravated. 7 cases developed deep venous embolism of lower limb and recovered through dextran intravenous drip and raise the limb. 7 patients with incision late healed recovered through change dressings and antibiotics. Incidence rate of complications of primitive method was 65.2% obviously higher than that of improve method （23.2%）. Among all complications, spinal cord injury and dura mater injury in primitive methods were far higher than improve method. Conclusion Spinal cord injury leaded to symptom increased was disaster complication and with severity consequence. The methods of patients with intervertebral disk hernia operated from thoracic cavity and patients with ossification of the yellow ligament and primarily diffuse hyperostosis and cartilage nodus of vertebral body posterior border were treated by drill and uncover method to remove vertebral plate and remove articular process by osteotome. Therefore, the complication rate can be reduced.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2007年第1期30-34,共5页
Chinese Journal of Orthopaedics
关键词
胸椎
椎管狭窄
手术中并发症
手术后并发症
Thoracic vertebrae
Spinal stenosis
Intraoperative complications
Postoperative complications
