摘要
目的总结脊柱结核一期手术治疗时围手术期并发症发生的原因。方法自1997年1月至2006年1月采用一期手术治疗胸、腰椎及腰骶段脊柱结核120例,男性75例,女性45例,年龄17～68岁,平均34.5岁。病变部位为 T_6～S_1。其中采用经前路病灶切除、椎体间植骨融合并内固定术65例,经后路病灶清除并内固定术26例,后路内固定并前路病灶切除、椎体间植骨融合术29例。记录术中、术后1个月内出现的并发症,并分析相关原因。结果共10例出现围手术期并发症,发生率为8.3%,其中死亡1例。并发症的主要发生原因:手术时机选择不当1例;手术创伤2例;手术操作不当或失误5例;其他原因2例。结论脊柱结核的一期手术治疗的围手术期并发症多是因处理不当引起。做好术前评估,术中操作谨慎,术后处理妥当,将可减少并发症的发生。
Objective To analyze the causes of perioperative complications of single-stage surgical management for spinal tuberculosis. Methods One hundred and twenty patients with thoracic, lumbar and lumbosacral spinal tuberculosis were treated by single-stage surgical management from January 1997 to January 2006 in our unit, including seventy-five males and forty-five females. The mean age was 34. 5 （range 17 to 68 ） years old. The lesion ranged from T6 to S,. The anterior procedures of anterior debridement, interbody fusion and anterior fixation were carried out in sixty-five cases, posterior procedures in twenty-six cases, and combined anterior and posterior procedures in twenty-nine cases, respectively. The complications that occurred during surgical procedure and 1 month after operation were recorded. Underlying causes were analysed. Results There were 10 cases （8.3%） were recorded of mild to severe complications during perioperative period in 120 patients. The complications and underlying causes were as follows ： （ 1 ） A patient died from liver failure and blood coagulation dysfunction after operation due to inappropriate surgical timing（n = 1 ）, in which case the patient with lumbosacral spinal tuberculosis also suffered from alcoholic liver sclerosis and dysfunction. （2） False diabetes insipidus （ n = 1 ） and deep vein thrombosis of lower limbs（ n = 1 ） occurred as result of surgical trauma. （3） Tear of iliac vein （n = 1 ） occurred with lumbosacral spinal tuberculosis because of unclear anatomical relationships when anterior debridement was performed. Injury of lumbar nerve roots （ n = 3 ） and hemothorax （ n = 1 ） also occurred due to mispractice of surgical procedures. （4） Paralysis intestinal obstruction and hypopotassium （n = 2 ） occurred after anterior procedures for lumbar spinal tuberculosis as a result of other reasons. Conclusions Improper perioperative care will lead to complications of single-stage surgical procedures for spinal tuberculosis. Emphasis should be put on preoperative evaluation, surgical planning, and postoperative caring for prevention of complications.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2007年第18期1230-1232,共3页
Chinese Journal of Surgery
关键词
结核
脊柱
外科手术
手术中并发症
Tuberculosis, spinal
Surgical procedures, operative
Intraoperative complication
