CAJ | 학술논문

目的：总结分析下腰椎退行性疾病后路手术相关早期并发症发生情况,探讨其发生原因及处理对策。方法回顾分析2005年10月—2011年10月我院采用后路手术治疗下腰椎退行性疾病784例的临床资料。结果784例中出现早期并发症80例(10.2%)。其中术后出现坐骨神经刺激症状36例(4.6%),对症治疗后症状消失。发生硬脊膜撕裂及脑脊液漏31例(4.0%),27例术中硬脊膜撕裂,缝合修补24例,3例裂口较小者取皮下脂肪覆盖；4例术后发现隐性脑脊液漏,延长引流至术后12 d或24 h引流量<50 ml拔除引流管。术中神经根损伤9例(1．1%),7例术后3个月内完全恢复,另2例遗留足背感觉麻木或足下垂。伤口深部感染4例(0.5%),2例行清创、保留内固定、抗感染治疗痊愈,1例行清创、取出内固定、抗感染治疗无效死亡,1例术后椎间隙感染经抗感染治疗痊愈。结论熟练掌握腰椎解剖知识、术中仔细操作、术后仔细观察、及时处理是防治下腰椎术后早期并发症的重要措施。
목적：총결분석하요추퇴행성질병후로수술상관조기병발증발생정황,탐토기발생원인급처리대책。방법회고분석2005년10월—2011년10월아원채용후로수술치료하요추퇴행성질병784례적림상자료。결과784례중출현조기병발증80례(10.2%)。기중술후출현좌골신경자격증상36례(4.6%),대증치료후증상소실。발생경척막시렬급뇌척액루31례(4.0%),27례술중경척막시렬,봉합수보24례,3례렬구교소자취피하지방복개；4례술후발현은성뇌척액루,연장인류지술후12 d혹24 h인류량<50 ml발제인류관。술중신경근손상9례(1．1%),7례술후3개월내완전회복,령2례유류족배감각마목혹족하수。상구심부감염4례(0.5%),2례행청창、보류내고정、항감염치료전유,1례행청창、취출내고정、항감염치료무효사망,1례술후추간극감염경항감염치료전유。결론숙련장악요추해부지식、술중자세조작、술후자세관찰、급시처리시방치하요추술후조기병발증적중요조시。
Objective To summarize and evaluate the cause and preventions of peri-operational complications associ-ated with surgical treatment for lumbar degenerative diseases. Methods A total of 784 patients with degenerative diseases of lumbar spine undergoing posterior surgical treatment between October 2005 and October 2011 were analyzed retrospectively. Results 80 cases (10. 2%) experienced peri-operation complications in 784 patients. The most common complication was temporary postsurgical sciatica (4. 6%, 36 patients), which was relieved after symptomatic treatment. There were 31 patients (4. 0%) with cerebrospinal fluid leakage, of the 27 patients with dural tears during the operations, 24 had the tear repair im-mediately, and 3 were covered by adipose tissue. 4 patients had CSF leakage without obvious dural tears during the surgery. Wound drainage was kept for 12 days post surgery or less than 50 ml of 24-hour-drainage for the treatment of CSF leakage. There were 9 patients (1. 1%) with neurological deficit after operation, 7 patients recovered completely in 3 months post sur-gery. Only one had numbness of dorsal foot and one had foot drop. Deep wound infections occurred in 4 patients (0. 5%), 2 of these patients recovered after debridement and systemic antibiotics treatments without removal of spinal instrumentation. One patient died of secondary multiple organs failure after debridement and implants extraction. One patient was successfully trea-ted with systemic antibiotics therapy only. Conclusion Comprehensive knowledge anatomy of the lumbar spine, appropriate surgical technique and intense careful skills during operation are critical in preventing, detecting, and managing complications in low back surgeries.