Fantini Gary A, Pappou Ioannis P, Girardi Federico P, Sandhu Harvinder S, Cammisa Frank P
Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York, USA.
Spine (Phila Pa 1976). 2007 Nov 15;32(24):2751-8. doi: 10.1097/BRS.0b013e31815a996e.
Retrospective chart review.
To examine the incidence of major vascular injury during anterior lumbar spinal surgery, attempt to identify predisposing risk factors, and to discuss management techniques.
Major vascular injury can be a catastrophic complication of anterior lumbar spinal surgery.
Current procedural terminology codes were used to identify the occurrence of major vascular injury, defined as injury to the iliac vessels, vena cava, and aorta. Once identified, the office record, hospital chart, operative note, and diagnostic test results were reviewed in detail.
Three hundred forty-five operations were performed on 338 patients. Incidence of major vascular complication was 2.9% (10 of 345). There were 9 injuries of the common iliac vein and a single aortic injury. Risk factors identified in patients with major vascular injury were current or previous osteomyelitis or discogenic infection (n = 3), previous anterior spinal surgery (n = 2), spondylolisthesis (n = 2; 1 isthmic Grade II, 1 iatrogenic Grade II), large anterior osteophyte (n = 2), transitional lumbosacral vertebra (n = 1), and anterior migration of interbody device (n = 1). Lateral venorrhaphy by suture (n = 6) and hemoclip application (n = 2) was augmented by topical agents, which constituted the sole method of repair on 1 occasion. Magnetic resonance venography demonstrated iliac vein thrombosis in 1 patient.
Current or previous osteomyelitis or discogenic infection, previous anterior spinal surgery, spondylolisthesis, osteophyte formation, transitional lumbosacral vertebra and anterior migration of interbody device point to an increased risk of vascular injury during anterior lumbar spinal surgery. Careful handling of the vascular structures and liberal use of topical hemostatic agents can lead to control of hemorrhage and preservation of vascular patency. Routine postoperative surveillance for proximal deep vein thrombosis, by magnetic resonance venography of the pelvic veins and inferior vena cava, should be performed after venorrhaphy.
回顾性病历审查。
研究腰椎前路手术期间主要血管损伤的发生率，尝试确定诱发风险因素，并探讨处理技术。
主要血管损伤可能是腰椎前路手术的灾难性并发症。
使用当前手术操作术语编码来识别主要血管损伤的发生情况，主要血管损伤定义为髂血管、腔静脉和主动脉损伤。一旦确定，详细查阅门诊记录、医院病历、手术记录和诊断检查结果。
对338例患者进行了345例手术。主要血管并发症的发生率为2.9%（345例中有10例）。其中9例为髂总静脉损伤，1例为主动脉损伤。在主要血管损伤患者中确定的风险因素包括当前或既往骨髓炎或椎间盘源性感染（n = 3）、既往腰椎前路手术（n = 2）、椎体滑脱（n = 2；1例峡部II级，1例医源性II级）、大的前方骨赘（n = 2）、腰骶移行椎（n = 1）和椎间融合器向前移位（n = 1）。通过缝合进行侧方静脉修补（n = 6）和应用血管夹（n = 2），并辅以局部用药，有1例仅采用了这种修复方法。磁共振静脉造影显示1例患者发生髂静脉血栓形成。
当前或既往骨髓炎或椎间盘源性感染、既往腰椎前路手术、椎体滑脱、骨赘形成、腰骶移行椎和椎间融合器向前移位表明腰椎前路手术期间血管损伤风险增加。小心处理血管结构并大量使用局部止血剂可控制出血并保持血管通畅。静脉修补术后应通过盆腔静脉和下腔静脉的磁共振静脉造影对近端深静脉血栓形成进行常规术后监测。
