CAJ | 학술논문

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。
목적：회고성분석흉추관협착증후로수술신경계통병발증발생적원인，병제출상응적처리대책。방법：자2008년1월～2014년1월경후로수술치료흉추관협착증환자101례，남52례，녀49례，년령32～81세，평균55.6세。단순흉추황인대골화89례，기중단절단29례，련속형56례，도약형4례；흉추후종인대골화3례；흉추간반돌출합병흉추황인대골화9례。균채용경후로“게개법”추판절제감압술。기록술중급술후신경계통병발증정황화상응적처리조시，수방환자신경공능AISA분급변화정황。결과：공유7례환자발생11례차신경계통병발증，발생솔위6.9%。기중척수손상2례차；경척막손상5례차；뇌척액루3례차；경막외혈종1례차。2례척수손상환자중，1례위술중감압과정조작불신손상，1례위술후경막외혈종치상，2례균경갑강룡충격치료，술후강복단련，척수공능불완전회복。1례경막외혈종급진행혈종청제술，술후전유。5례경척막파손자4례경척막손상술중행경척막수보，1례미여수보，술후균가압포찰급생물단백효봉폐，기중3례발생뇌척액루，경방치인류、엄밀봉합급보충수전해질등처리치유。7례환자균획득수방，수방시간5~62개월，평균수방26개월，술전2례ASIA B급환자말차수방시1례개선위C급，1례개선위D급；4례ASIA C급환자2례개선위D급，2례개선위E급；1례ASIA D급환자개선위E급。결론：흉추관협착증후로수술신경계통병발증유일정적발생솔，술중규범정심조작，술후급시유효처리시감소화방치병발증적관건。
Objectives: To analyze the causes and management of neurological complications following poste-rior approach surgery for thoracic spinal stenosis. Methods: 101 patients with thoracic spinal stenosis under-going 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. Ossifica-tion 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 recov-ery of ASIA classification. Results: Neurological complications were noted in 11 cases(7 patients) with an in-cidence 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 opera-tion. 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 complica-tions 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 complica-tions.