椎间孔镜手术出现失误及并发症的原因与预防措施

摘要

目的 分析椎间孔镜治疗腰椎退行性疾病出现手术失误及并发症的原因并探讨其处理和预防措施.方法 回顾性分析2012年7月至2016年1月我科使用椎间孔镜技术治疗腰椎退行性疾病660例患者的临床资料,其中腰椎间盘突出症528例,单节段(L4/L5)192例,多节段336例;腰椎管狭窄症132例,均为侧隐窝及神经根管通道狭窄.观察并记录手术失误及并发症,分析其原因,探讨处理方法及预防措施.结果 术中失误:无菌贴膜随扩张导管进入术区1例;导丝断裂,残端留置体内1例;椎间盘造影染色时,混合液稀释比例不够,浓度过高的亚甲蓝外漏造成马尾神经损伤3例;扩大椎间孔时,环钻切割部分上关节突操作过深、过于靠近关节突內侧壁,致神经纤维鞘切割伤2例;硬膜囊撕裂后冲洗液逆行灌流,引起腹胀、颅压升高、血压升高等类脊髓高压症表现3例;小剂量局部麻醉药物入血引起毒性反应2例;椎旁神经根阻滞时发生全脊髓麻醉1例.术后并发症:神经根水肿3例;游离髓核组织残留2例;局部血肿压迫神经根2例;椎间隙感染1例;穿刺区局部皮神经炎3例.结论 在椎间孔镜手术中往往会有一些手术器械上亦或是技术操作上的不足,严谨对待围手术期的每一个环节才是手术成功的保障.%Objective To analyze the causes of surgical errors and complications of lumbar degenerative diseases treated by transforaminal endoscopic spine system(TESSYS),and explore the treatment and prevention measures.Methods From July 2012 to January 2016,the data of 660 patients with lumbar degenerative diseases who treated with TESSYS were analyzed retrospectively,of which 528 patients were lumbar disc herniation with 192 cases of single segment(L4/L5) and 336 cases of multi-segment.Lumbar spinal stenosis in 132 cases,were lateral recess and nerve root canal stenosis.Surgical errors and complications were recorded,and analyzed the reasons and the treatment and preventive measures.Results Intraoperative errors:1 case of sterile film with the dilating catheter went into the surgical area;1 case with wire fracture,and stump retention in vivo;for discography staining,the proportion of mixed solution was not enough,the leakage of excess concentration of methylene blue caused caudal nerve injury in 3 cases;expansion of the intervertebral foramen,the drilling part of the articular process was too deep and too close to the medial wall of the articular process,which caused cutting injury of nerve fiber sheath in 2 cases;after the rupture of the dura mater,the rinse solution was perfused,caused bloating,elevated intracranial pressure,elevated blood pressure and other symptoms of spinal cord hypertension in 3 cases;low dose of local anesthetic into the blood caused toxic reaction in 2 cases;total spinal cord anesthesia with paravertebral nerve root block in 1 case.Postoperative complications:3 cases of nerve root edema;2 cases of free nucleus pulposus tissue;2 cases of local hematoma led to nerve root compression;1 case of intervertebral space infection and 3 cases of local skin neuritis in the puncture area.Conclusion In the process of intervertebral foramen surgery,there are some deficiency on instruments or operating skill.Therefore,rigorous treatment of each link in the perioperative period,is the guarantee of successful surgery.