• 徐州市第一人民醫(yī)院骨科（江蘇徐州，221000）;

【摘要】　目的　 探討頸椎手術(shù)并發(fā)癥原因及預(yù)防措施，以提高手術(shù)成功率。　方法　 對(duì)2000年5月-2009年5月實(shí)施頸椎前路手術(shù)的脊髓型頸椎病患者201例中20例發(fā)生并發(fā)癥患者的臨床資料及隨訪情況進(jìn)行回顧性分析。　結(jié)果　 20例并發(fā)癥患者獲得隨訪時(shí)間3個(gè)月～10年，平均5.5年。近期并發(fā)癥11例，發(fā)生率5.47%；遠(yuǎn)期并發(fā)癥9例，發(fā)生率4.48%。　結(jié)論　 充分認(rèn)識(shí)脊髓的損傷類(lèi)型，仔細(xì)評(píng)估患者的全身情況，熟練的手術(shù)操作，良好的術(shù)后護(hù)理是手術(shù)成功的關(guān)鍵。
【Abstract】　Objective　 To investigate the reasons of and prevention for surgical complications of anterior cervical spine.　Methods　 The clinical data of 20 patients with surgical complications in 201 patients who underwent anterior cervical surgery from May 2000 to May 2009 were analyzed retrospectively.　Results　 The patients with complications were followed up for 3 months to 10 years with an average of 5.5 years. The rate of 11 patients with short-term complications was 15%, and the rate of nine patients with long-term complications was 4.48%.　Conclusion　 The key of a successful surgery for anterior cervical spine inludes full realization of type of cervical spinal cord injury, careful evaluation of the patient’s general condition, skilled operation, and good post-operative care.

引用本文： 鄭軍,楊效寧,曹雷. 頸椎前路手術(shù)20例并發(fā)癥治療分析. 華西醫(yī)學(xué), 2011, 26(1): 51-53. doi: 復(fù)制

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1. 　Kaner T, Sasani M, Okteno?lu T, et al. Clinical outcomes following cervical laminoplasty for 19 patients with cervical spondylotic myelopathy[J]. Turk Neurosurg, 2009, 19(2): 121-126.
2. 　Hannallah D, Lee J, Khan M, et al. Cerebrospinal fluid leaks following cervical spine surgery[J]. J Bone Joint Surg Am, 2008, 90(5): 1101-1105.
3. 　Phommachanh V, Patil YJ, McCaffrey TV, et al. Otolaryngologic management of delayed pharyngoesophageal perforation following anterior cervical spine surgery[J]. Laryngoscope, 2010, 120(5): 930-936.
4. 　Apfelbaum RI, Kriskovich MD, Haller JR. On the incidence, cause, and prevention of recurrent laryngeal nerve palsies during anterior cervical spine surgery[J]. Spine (Phila Pa 1976), 2000, 25(22): 2906-2912.
5. 　Jung A, Schramm J. How to reduce recurrent laryngeal nerve palsy in anterior cervical spine surgery: a prospective observational study[J]. Neurosurgery, 2010, 67(1): 10-15, discussion 15.
6. 　Patel NP, Wolcott WP, Johnson JP, et al. Esophageal injury associated with anterior cervical spine surgery[J]. Surg Neurol, 2008, 69(1): 20-24, discission 24.
7. 　Kriskovich MD, Apfelbaum RI, Haller JR. Vocal fold paralysis after anterior cervical spine surgery: incidence, mechanism, and prevention of injury[J]. Laryngoscope, 2000, 110(9): 1467-1473.
8. 　Hasegawa K, Homma T, Chiba Y. Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion[J]. Spine (Phila Pa 1976), 2007, 32(6): E197-202.
9. 　Wright IP, Eisenstein SM. Anterior cervical discectomy and fusion without instrumentation[J]. Spine (Phila Pa 1976), 2007, 32(7): 772-774, discussion 775.
10. 　Hannallah D, Lee J, Khan M, et al. Cerebrospinal fluid leaks following cervical spine surgery[J]. J Bone Joint Surg Am, 2008, 90(5): 1101-1105.
11. 　Nakra D, Bala I, Pratap M. Unilateral postoperative visual loss due to central retinal artery occlusion following cervical spine surgery in prone position[J]. Paediatr Anaesth, 2007, 17(8): 805-808.
12. 　Fujibayashi S, Shikata J, Kamiya N, et al. Missing anterior cervical plate and screws: a case report[J]. Spine (Phila Pa 1976), 2000, 25(17): 2258-2261.
13. 　陳雄生, 賈連順, 曹師鋒, 等. 頸椎前路手術(shù)的并發(fā)癥[J]. 中華骨科雜志, 2003, 23(11): 644-649.
14. 　Farey ID, McAfee PC, Davis RF, et al. Pseudarthrosis of the cervical spine after anterior arthrodesis. Treatment by posterior nerve-root decompression, stabilization, and arthrodesis[J]. J Bone Joint Surg Am, 1990, 72(8): 1171-1177.
15. 　Bohlman HH, Kirkpatrick JS, Delamarter RB, et al. Anterior decompression for late pain and paralysis after fractures of the thoracolumbar spine[J]. Clin Orthop Relat Res, 1994, (300): 24-29.
16. 　Schneeberger AG, Boos N, Schwarzenbach O, et al. Anterior cervical interbody fusion with plate fixation for chronic spondylotic radiculopathy: a 2- to 8-year follow-up[J]. J Spinal Disord 1999, 12(3): 215-220, discussion 221.
  1. 1. 　Kaner T, Sasani M, Okteno?lu T, et al. Clinical outcomes following cervical laminoplasty for 19 patients with cervical spondylotic myelopathy[J]. Turk Neurosurg, 2009, 19(2): 121-126.
  2. 2. 　Hannallah D, Lee J, Khan M, et al. Cerebrospinal fluid leaks following cervical spine surgery[J]. J Bone Joint Surg Am, 2008, 90(5): 1101-1105.
  3. 3. 　Phommachanh V, Patil YJ, McCaffrey TV, et al. Otolaryngologic management of delayed pharyngoesophageal perforation following anterior cervical spine surgery[J]. Laryngoscope, 2010, 120(5): 930-936.
  4. 4. 　Apfelbaum RI, Kriskovich MD, Haller JR. On the incidence, cause, and prevention of recurrent laryngeal nerve palsies during anterior cervical spine surgery[J]. Spine (Phila Pa 1976), 2000, 25(22): 2906-2912.
  5. 5. 　Jung A, Schramm J. How to reduce recurrent laryngeal nerve palsy in anterior cervical spine surgery: a prospective observational study[J]. Neurosurgery, 2010, 67(1): 10-15, discussion 15.
  6. 6. 　Patel NP, Wolcott WP, Johnson JP, et al. Esophageal injury associated with anterior cervical spine surgery[J]. Surg Neurol, 2008, 69(1): 20-24, discission 24.
  7. 7. 　Kriskovich MD, Apfelbaum RI, Haller JR. Vocal fold paralysis after anterior cervical spine surgery: incidence, mechanism, and prevention of injury[J]. Laryngoscope, 2000, 110(9): 1467-1473.
  8. 8. 　Hasegawa K, Homma T, Chiba Y. Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion[J]. Spine (Phila Pa 1976), 2007, 32(6): E197-202.
  9. 9. 　Wright IP, Eisenstein SM. Anterior cervical discectomy and fusion without instrumentation[J]. Spine (Phila Pa 1976), 2007, 32(7): 772-774, discussion 775.
  10. 10. 　Hannallah D, Lee J, Khan M, et al. Cerebrospinal fluid leaks following cervical spine surgery[J]. J Bone Joint Surg Am, 2008, 90(5): 1101-1105.
  11. 11. 　Nakra D, Bala I, Pratap M. Unilateral postoperative visual loss due to central retinal artery occlusion following cervical spine surgery in prone position[J]. Paediatr Anaesth, 2007, 17(8): 805-808.
  12. 12. 　Fujibayashi S, Shikata J, Kamiya N, et al. Missing anterior cervical plate and screws: a case report[J]. Spine (Phila Pa 1976), 2000, 25(17): 2258-2261.
  13. 13. 　陳雄生, 賈連順, 曹師鋒, 等. 頸椎前路手術(shù)的并發(fā)癥[J]. 中華骨科雜志, 2003, 23(11): 644-649.
  14. 14. 　Farey ID, McAfee PC, Davis RF, et al. Pseudarthrosis of the cervical spine after anterior arthrodesis. Treatment by posterior nerve-root decompression, stabilization, and arthrodesis[J]. J Bone Joint Surg Am, 1990, 72(8): 1171-1177.
  15. 15. 　Bohlman HH, Kirkpatrick JS, Delamarter RB, et al. Anterior decompression for late pain and paralysis after fractures of the thoracolumbar spine[J]. Clin Orthop Relat Res, 1994, (300): 24-29.
  16. 16. 　Schneeberger AG, Boos N, Schwarzenbach O, et al. Anterior cervical interbody fusion with plate fixation for chronic spondylotic radiculopathy: a 2- to 8-year follow-up[J]. J Spinal Disord 1999, 12(3): 215-220, discussion 221.