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中华骨科杂志  2016, Vol. 36 Issue (17): 1133-1141    DOI: 10.3760/cma.j.issn.0253-2352.2016.17.010
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颈椎手术并发症的研究进展
钱闯,陈雄生
200003 上海,第二军医大学附属长征医院骨科医院脊柱三科
Qian Chuang, Chen Xiongsheng
Qian Chuang,Chen Xiongsheng
Department of Spine Surgery, Orthopaedics Hospital in Shanghai Changzheng Hospital, Second Military Medical University, Shanghai200003, China
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摘要 颈椎伤病的手术治疗经过一个多世纪的发展,临床效果得到了大幅度的提升,关于颈椎手术并发症的研究也随之深入,通过文献回顾性研究,总结颈椎手术并发症的研究进展。临床上常见的手术并发症包括血肿、硬膜囊破裂、术后感染、C5神经根麻痹、喉返神经损伤、喉上神经损伤及轴性痛等,一些少见的并发症近年来也时有报告,如食管损伤、霍纳综合征、椎动脉损伤以及上颈椎后路手术引起的吞咽困难和呼吸困难等。颈椎内固定物的应用为临床疗效的提高提供了非常有益的支持,但其相关并发症的文献报道亦逐年有所增加,主要包括内固定物的移位、断裂以及与颈椎人工椎间盘置换术相关的特殊并发症等。并发症的预防和治疗是临床的关键问题,对于病因比较明确者,如颈椎前路术后软组织血肿和椎管内血肿、喉返神经损伤、喉上神经损伤、硬膜囊损伤等,临床的预防与治疗措施已有较多的共识,精准有效的手术操作是最基本的要求。但是对于某些病因尚不完全明确者,如C5神经根麻痹、吞咽困难、轴性痛等,其治疗除了对症处理外,对术中操作的要求仍无公认的标准,需要进一步的研究。内固定物相关的并发症除了手术操作和患者自身因素可以通过医疗过程进行有效控制外,其本身在材料和设计上的问题往往需要结合前沿科技进行改良来进一步提高其临床应用效果。
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钱闯
陈雄生
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Abstract: For more than a century, the treatment of cervical disorders has been greatly improved. The researches for the complications of cervical spine surgery have been enhanced during the same period. The objective of this paper is to summarize the progressive results of researches on the complications of cervical spine surgery through literature review. Common surgical complications include hematoma, dural tear, postoperative infection, C5 nerve root palsy, recurrent/superior laryngeal nerve injury, axial pain, etc. Rare complications such as esophageal injury, Horner's syndrome, vertebral artery injury, dysphagia and dyspnea caused by posterior upper cervical spine surgery have also been reported in recent years. The application of cervical instruments provides great support for the improvement of clinical efficacy. However, reports about the related complications also increases year by year, including implant displacement or broken, and special complications associated with cervical artificial disc replacement. Prevention and treatment of complications is the key in clinical practice. For those complications which already have relatively clear causes, such as soft tissue or spinal cannel hematoma, recurrent/superior laryngeal nerve injury, dural tear, accurate and effective operation is highly suggested. However, there's still no standard of operating process for preventing the complications (C5 nerve root palsy, dysphagia, axial pain, etc.), whose pathogeny are still unclear, and further studies are needed in the future. Instrument related complications caused by mal-operation or abnormal patient condition can be effectively controlled through correct medical procedures. Those instrument shortcomings of material or design aspects need to be improved by the auxiliary of cutting-edge technology for further improvement of the results of clinical application.
Key words:   
收稿日期: 2016-08-20;
基金资助:

上海市医学重点项目(12411951300)

作者简介: 陈雄生,E-mail: chenxiongsheng@vip.sohu.com
引用本文:   
钱闯,陈雄生. 颈椎手术并发症的研究进展[J]. 中华骨科杂志, 2016, 36(17): 1133-1141.
Qian Chuang,Chen Xiongsheng. Qian Chuang, Chen Xiongsheng[J]. Chin J Orthop, 2016, 36(17): 1133-1141.
链接本文:  
http://www.chinjorthop.com/Jwk_zhgkzz/CN/10.3760/cma.j.issn.0253-2352.2016.17.010      或     http://www.chinjorthop.com/Jwk_zhgkzz/CN/Y2016/V36/I17/1133
 
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