脊柱结核手术治疗的并发症原因分析及防治

Cause analysis and prevention of the complications after surgical treatment for spinal tuberculosis

中文关键词:  脊柱  结核  并发症  防治

英文关键词:Spinal  Tuberculosis  Complications  Prevention

中文摘要:

  【摘要】 目的：总结分析脊柱结核手术治疗的并发症种类、原因、临床治疗方案及预防措施。方法：回顾性分析2004年6月～2009年12月采用手术治疗306例脊柱结核患者的临床资料。其中男173例，女133例，年龄17～68岁，平均34.5岁。颈椎结核16例，颈胸椎结核5例，胸椎结核77例，胸腰椎结核104例，腰椎结核76例，腰骶椎结核28例。分别采用前路和／或后路病灶清除、植骨融合或加行内固定术。记录术中、术后并发症情况，分析其原因并提出相应处理对策及预防措施。结果：完整随访296例，随访时间为6～36个月，平均18个月。47例出现并发症，发生率为15.4％，其中5例胸腹膜损伤、4例髂外静脉损伤、3例神经功能障碍、8例术后感染、4例手术应激反应及3例下肢深静脉栓塞患者经相应的保守治疗后好转；4例喉头水肿引起呼吸困难者，均行气管切开，2例死亡；5例脑脊液漏者，3例行蛛网膜下腔持续引流术，２例保守治疗后好转；2例早期植骨排异反应，行植骨清除术；2例内固定松动、断裂者，行内固定取出术；7例愈合后复发者，2例行前路病灶清除术、1例行前路病灶清除前路内固定术、2例行前路病灶清除椎弓根内固定，２例行保守治疗；手术处理患者术后伤口均一期愈合，无复发。结论：脊柱结核术后并发症不可忽视，在规则药物治疗基础上，严格把握手术指征、采取正确的手术方式、注意辨认术中复杂的解剖结构、提高手术技巧及有效的围手术期处理是防治并发症的关键。

英文摘要:

  【Abstract】 Objective：To explore the types，causes，treatment plans and prevention of the complications after surgical treatment for spinal tuberculosis.Method：306 cases of spinal tuberculosis undergoing posterior or anterior debridement，bone graft with or without instrumentation from June 2004 to December 2009 were retrospectively reviewed，including 173 males and 133 females，with the mean age of 34.5 years old（range， 17 to 68 years）．Of them，there were 16 cervical tuberculosis，5 cervicothoracic tuberculosis，77 thoracic tuberculosis，104 thoracolumbar tuberculosis，76 lumbar tuberculosis and 28 lumbosacral tuberculosis.All cases were followed-up for an average of 18 months（6 months-3 years）．The causes of complications and corresponding interventions were documented.Result：10 cases were lost during follow-up and complications were noted in 47 patients（15.4%）.Injury of pleuroperitoneum was noted in 5 cases，injury of external iliac vein in 4 cases，neurological deficit in 3 cases.Surgical stress reaction occurred in 4 cases and deep vein thrombosis occurred in 3 cases which were all resolved after corresponding conservative treatment；4 cases were complicated with dyspnoea，of who 2 died，CSF leakage was noted in 5 cases，3 underwent consistent drainage and 2 recovered.2 cases suffered early-stage bony graft related to complication which resolved by debridement;instrument failure were noted in 2 cases；7 cases were noted tuberculosis recurrence，of who，2 underwent single anterior debridement，2 underwent anterior debridement and instrumentation，2 underwent anterior debridement plus posterior pedicle screw fixation，while 2 cases underwent conservative treatment.The skin incision healed primarily in all patients.Conclusion：Postoperative complications of spinal tuberculosis should be taken into account.Strict chemotherapy and strict surgical indications，proper surgical maneuver are key to preventing the complications.