胸椎管狭窄症后路手术神经系统并发症发生原因及处理

The causes and management of the neurological complications following posterior approach surgery for thoracic spinal stenosis

中文关键词:  胸椎管狭窄症  后路手术  神经系统并发症  处理

英文关键词:Thoracic spinal stenosis  Posterior approach surgery  Neurological complications  Management

中文摘要:

  【摘要】 目的：回顾性分析胸椎管狭窄症后路手术神经系统并发症发生的原因，并提出相应的处理对策。方法：自2008年1月～2014年1月经后路手术治疗胸椎管狭窄症患者101例，男52例，女49例，年龄32～81岁，平均55.6岁。单纯胸椎黄韧带骨化89例，其中单节段29例，连续型56例，跳跃型4例；胸椎后纵韧带骨化3例；胸椎间盘突出合并胸椎黄韧带骨化9例。均采用经后路“揭盖法”椎板切除减压术。记录术中及术后神经系统并发症情况和相应的处理措施，随访患者神经功能AISA分级变化情况。结果：共有7例患者发生11例次神经系统并发症，发生率为6.9%。其中脊髓损伤2例次；硬脊膜损伤5例次；脑脊液漏3例次；硬膜外血肿1例次。2例脊髓损伤患者中，1例为术中减压过程操作不慎损伤，1例为术后硬膜外血肿致伤，2例均经甲强龙冲击治疗，术后康复锻炼，脊髓功能不完全恢复。1例硬膜外血肿急诊行血肿清除术，术后痊愈。5例硬脊膜破损者4例硬脊膜损伤术中行硬脊膜修补，1例未予修补，术后均加压包扎及生物蛋白胶封闭，其中3例发生脑脊液漏，经放置引流、严密缝合及补充水电解质等处理治愈。7例患者均获得随访，随访时间5~62个月，平均随访26个月，术前2例ASIA B级患者末次随访时1例改善为C级，1例改善为D级；4例ASIA C级患者2例改善为D级，2例改善为E级；1例ASIA D级患者改善为E级。结论：胸椎管狭窄症后路手术神经系统并发症有一定的发生率，术中规范精心操作，术后及时有效处理是减少和防治并发症的关键。

英文摘要:

  【Abstract】 Objectives: To analyze the causes and management of neurological complications following posterior approach surgery for thoracic spinal stenosis. Methods: 101 patients with thoracic spinal stenosis undergoing posterior approach surgery from January 2008 to January 2014 were reviewed retrospectively. 52 males and 49 females with a mean age of 55.6 years( range, 32 to 81 years) were included in this study. Ossification of longitudinal flavum(OLF) was noted in 89 cases, ossification of posterior longitudinal ligament(OPLL) and thoracic disc herniation complicated with ossification of longitudinal flavum was noted in 3 and 9 cases respectively. 89 OLF cases consisted of 29 single-segment OLF, 56 multi-segment OLF and 4 non-continuous OLF cases. The causes of complications and corresponding interventions were documented. Record the recovery of ASIA classification. Results: Neurological complications were noted in 11 cases(7 patients) with an incidence rate of 6.9%. There were 2 cases with spinal cord injury, 5 cases with dural injury, 3 cases with cerebrospinal fluid leakage and 1 case with epidural hematoma. 1 case of spinal cord injury was noted due to careless operation during the surgery and the other was due to the epidural hematoma; both of the 2 cases with spinal cord injury were treated by Methylprednisolone and rehabilitation exercise which partially restored the spinal cord function. 1 case underwent emergency operation due to epidural hematoma. 5 cases with dural injury were treated by pressure dressing and fibrin glue, 4 of whom had the dura repaired during the operation. Among all the cerebrospinal fluid leakage cases, 3 had dura repaired and recovered completely after drainage and corresponding support management. All the 7 patients were followed up from 5 to 62 months with an average of 26 months, 2 patients of ASIA B pre-operatively improved to C and D respectively at the final follow-up; 2 patients of ASIA C improved to D, and all the other patients with neurological complications improved to E. Conculsions： The morbidities of posterior approach surgery for thoracic spinal stenosis is high, the careful and effective management is critical to decrease and/or prevent the incidence of complications.