摘要
目的总结通道下肌间隙入路腰椎固定融合术并发神经损伤的特点,分析损伤原因并提出预防措施。方法武警浙江省总队医院2012年6月—2015年12月由同一组医师采用通道下肌间隙入路固定融合术治疗的腰椎病变患者277例,其中9例出现神经损伤(男4例、女5例),年龄42~78岁,平均56.7岁。腰丛损伤1例,马尾神经损伤1例,神经根损伤7例。手术操作损伤3例,螺钉位置不正确损伤2例,血肿压迫2例,混合因素1例,原因不明1例。予非手术治疗5例,再次手术4例。结果 9例患者随访9~36个月,平均22.5个月。末次随访时,手术操作直接损伤的3例中2例部分恢复,1例完全恢复;2例椎弓根螺钉位置不正确所致的神经根损伤完全恢复;2例血肿压迫所致神经损伤者1例完全恢复,另1例大部分恢复;混合因素导致马尾神经损伤的1例患者部分恢复;损伤原因不明的1例完全恢复。结论通道下肌间隙入路腰椎固定融合术的神经并发症以神经根损伤多见。神经损伤有显露和手术方式的客观原因,但术者的操作可能是更主要的因素。术前应严格选择病例、术中操作要谨慎细致,以预防神经损伤的发生。
Objective To summarize the characteristics of the nerve injury in posterior lumbar internal fixation and interbody fusion through muscle gap using expandable channel,analyze the causes for the injury and put forward the preventive measures. Methods Nine patients（4 males and 5 females） suffered nerve injury who underwent lumbar fusion through muscle gap using expandable channel by the same group of doctors from June 2012 to December 2015 in Hospital of Zhejiang General Corps of Armed Police Forces. The mean age was 56.7 years（42-78 years）. Among them,1 patient showed cauda equina injury,1 lumbar plexus nerve injury,7 nerve root injury. The causes for nerve injury were iatrogenic surgical injury in 3 cases,incorrect screw position in 2,hematoma compression in 2,mixed factors in 1 and unknown origin in 1. Four patients received reoperation and 5 concervative treament. Results All patients were followed up for 9-36 months（mean 22.5 months）. To the end of the follow-up,1 patient obtained complete recovery and 2 partial recovery in 3 patients with surgical injury. The 2 patients with nerve root injury due to incorrect screw position obtained complete recovery. In 2 patients nerve injury due to hematoma compression,one obtained complete recovery and the other obtained most of recovery. The mixed factors-injured patient obtained partial recovery and the unknown origin-injured patient obtained complete recovery. Conclusion The nerve root injury is the most common neurologic complication of the posterior lumbar internal fixation and interbody fusion through muscle gap using expandable channel. For the nerve injury,there are objective reasons for the exposure and operation mode,but the operation of the surgeon may be the more important factor. For the prevention of nerve injury,it requires not only the abundant experience of the surgeon,but also strict selection of surgical indications,and meticulous operation in surgery.
出处
《脊柱外科杂志》
2017年第4期211-216,共6页
Journal of Spinal Surgery
基金
浙江省卫生厅科研项目(2010KYB112)
关键词
腰椎
脊柱融合术
内固定器
外科手术
微创性
手术中并发症
Lumbar vertebrae
Spinal fusion
Internal fixators
Surgical procedures, minimally invasive
Intraoperative complications
