目的 探讨下腰椎手术椎弓根钉置钉过程中毗邻椎前大血管损伤的原因、诊断与预防.方法 回顾8例腰椎弓根钉内固定手术中发生椎前血管损伤的原因、诊断和治疗过程.结果 术中死亡2例,术后发现腹膜后血肿形成3例,血管瘤形成3例,对症处理后无主观不适症状.结论 下腰椎前毗邻血管损伤与手术操作、解剖、血管病理变化等因素有关,术者熟悉解剖结构,术前充分了解血管变异情况及术中精准操作是预防椎前血管损伤的前提.术中如突然出现血压急骤下降时,应即想到有损伤腹腔大血管的可能.早期诊断,一旦确诊,及时剖腹探查止血,是救治的有效方法.%Objective To study the reasons,diagnosis and prevention of vascular injury when we put pedicle screw through the pedicle of lower lumbar vertebra. Methods 8 cases of anterior vertebra vessel injury during lumbar spine surgery were reviewed,alout the reasons,eraly diagnosis and teatments. Results Two patients died in operation,three patients diagnosed as retroperitoneal haematoma formation afteroperation,and three cases diagnozed as hemangioma,but no symptoms after correct treatment. Conclusion Injury of anterior vertebra vessel due to factors such as operative procedure,anatomic variance,calcified vascular wall. In order to prevent injury,firstly surgeons should be familiar with anatomy of anterior vertebra vessel,be sure about vessel variation and be careful during operation. And once patient's blood pressure drop down quickly,surgeons should think of vascular injury in abdominal cavity immediately. The key point is to diagnozed early and turn to abdominal surgical treatment as early as possible.
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