摘要
目的总结分析下腰椎退行性疾病后路手术相关早期并发症发生情况,探讨其发生原因及处理对策。方法回顾分析2005年10月—2011年10月我院采用后路手术治疗下腰椎退行性疾病784例的临床资料。结果784例中出现早期并发症80例(10.2%)。其中术后出现坐骨神经刺激症状36例(4.6%),对症治疗后症状消失。发生硬脊膜撕裂及脑脊液漏31例(4.0%),27例术中硬脊膜撕裂,缝合修补24例,3例裂口较小者取皮下脂肪覆盖;4例术后发现隐性脑脊液漏,延长引流至术后12 d或24 h引流量<50 ml拔除引流管。术中神经根损伤9例(1.1%),7例术后3个月内完全恢复,另2例遗留足背感觉麻木或足下垂。伤口深部感染4例(0.5%),2例行清创、保留内固定、抗感染治疗痊愈,1例行清创、取出内固定、抗感染治疗无效死亡,1例术后椎间隙感染经抗感染治疗痊愈。结论熟练掌握腰椎解剖知识、术中仔细操作、术后仔细观察、及时处理是防治下腰椎术后早期并发症的重要措施。
Objective To summarize and evaluate the cause and preventions of peri-operational complications associated with surgical treatment for lumbar degenerative diseases. Methods A total of 784 patients with degenerative diseases of lumbar spine undergoing posterior surgical treatment between October 2005 and October 2011 were analyzed retrospectively.Results 80 cases（10. 2%） experienced peri-operation complications in 784 patients. The most common complication was temporary postsurgical sciatica（4. 6%,36 patients）,which was relieved after symptomatic treatment. There were 31 patients（4. 0%） with cerebrospinal fluid leakage,of the 27 patients with dural tears during the operations,24 had the tear repair immediately,and 3 were covered by adipose tissue. 4 patients had CSF leakage without obvious dural tears during the surgery.Wound drainage was kept for 12 days post surgery or less than 50 ml of 24-hour-drainage for the treatment of CSF leakage.There were 9 patients（1. 1%） with neurological deficit after operation,7 patients recovered completely in 3 months post surgery. Only one had numbness of dorsal foot and one had foot drop. Deep wound infections occurred in 4 patients（0. 5%）,2of these patients recovered after debridement and systemic antibiotics treatments without removal of spinal instrumentation. One patient died of secondary multiple organs failure after debridement and implants extraction. One patient was successfully treated with systemic antibiotics therapy only. Conclusion Comprehensive knowledge anatomy of the lumbar spine,appropriate surgical technique and intense careful skills during operation are critical in preventing,detecting,and managing complications in low back surgeries.
出处
《临床误诊误治》
2015年第1期33-37,共5页
Clinical Misdiagnosis & Mistherapy
基金
北京市科技计划课题(Z121107001012096)
关键词
椎间盘退行性变
外科手术
手术后并发症
Lumbar spine
Degenerative disease
Peri-operation complication
