摘要
目的:探讨颈椎前路手术的并发症及其处理方法。方法:2000年5月至2006年5月共行颈椎前路手术523例,手术方式采用环锯减压+cage或植骨+带锁钢板固定278例;椎体次全切除或颈前路开槽减压+钛网植骨+带锁钢板固定245例。术后随访403例,随防内容包括症状及体征的改善情况,并每月进行一次颈椎X线检查。结果:随访6个月至6年,平均2年10个月,81例患者出现并发症。其中猝死2例,喉头痉挛、气管痉挛,堵塞呼吸道可能为其死亡原因;术后切口皮下血肿3例,经床头紧急清除血肿后呼吸困难解除;颈脊髓或神经根损伤6例,经脱水治疗后恢复满意;喉返神经损伤1例,喉上神经损伤3例,3个月内基本恢复正常;切口感染2例,经抗感染、换药治疗后愈合;脑脊液漏2例,经局部适度加压后愈合;钢板螺钉松动钛网移位1例,经再次手术取出钢板,重新放置钛网植骨,钢板重新固定,3个月后植骨融合;植骨未愈合2例,均再次手术植骨钢板固定,3个月后植骨融合;内置物下沉、椎间高度丢失13例,经颈领固定,3-6个月内均获得椎间融合;相邻节段退变19例,无症状未特殊处理;颈部疼痛27例,给予口服非甾体药物,21例患者疼痛缓解。结论:颈椎病前路手术可发生多种并发症,应积极预防及进行相应的处理。
Objective：To explore and analyze the complications and the treatments of the anterior cervical spine operation.Method：From May 2000 to May 2006,a total of 523 patients with cervical spondylosis underwent ACDF.Surgical protocols included anterior decompression,cage or bone graft plus locking plate stabilization in 278 cases;anterior decompression by subtotal resection of vertebral body,titanium mesh implantation plus locking plate fixation in 245 casesA03 patients were followed-up from 6 months to 7 years with an average of two years and 10 months.The improvement of the clinical symptoms and physical signs were reviewed and radiological findings were recorded once a month after surgery.Result：Complications appeared in 81 patients,among them,there was sudden death in 2 cases,the causes might be larynx spasm,trachea spasm or respiratory tract obstruction;3 cases had intra-incision hematoma,after removing the hematoma,the dyspnea relieved.6 cases had the injuries to spinal cords or cervical nerve roots,after giving dehydrate medicine,these patients recovered satisfiedly;1 case had injury to recurrent laryngeal nerve,3 cases had injury to superior laryngeal nerve and all these complications disappeared in three months;2 cases had incision infection,which was healed by anti-infection medicine;2 cases had cerebrespinal fluid leakage,which recovered by giving correspondent treatment.Instrument displacement appeared in 1 case,after replacing the original instrument with a set of new implantation,bony fusion was evidenced in 3 months.Nun-union was noted in 2 cases,both of them underwent the revisional surgery,finally bony fusion was evidenced in 3 months.13 cases had implant subsidence and lose of interbody height,which was cured followed by collar fixation and bony fusion was evidenced in 3-6 months.Adjacent segment degeneration appeared in 19 cases,and all of them got no correspondent treatment.Axial pain appeared in 27 cases,and 21 of which had pain relieved by oral administration of non-steroid drugs.Conclusion：Complications may be associated with anterior cervical operation due to cervical spondylosis,proper prevention and interference may help to resolve these.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2007年第8期567-570,共4页
Chinese Journal of Spine and Spinal Cord
关键词
颈椎病
手术
并发症
Cervical spondylosis
Operation
Complications
