Klezl Zdenek, Swamy Girish Nanjunda, Vyskocil Thomas, Kryl Jan, Stulik Jan
Department of Trauma and Orthopaedics, Royal Derby Hospital, Derby, UK. ; Department of Spinal Surgery, Charles University Medical School, Prague, Czech Republic.
Department of Trauma and Orthopaedics, Royal Derby Hospital, Derby, UK.
Asian Spine J. 2014 Feb;8(1):59-63. doi: 10.4184/asj.2014.8.1.59. Epub 2014 Feb 6.
Modern biomaterials and instrumentation have popularised surgery of the thoraco-lumbar spine through an anterior route. The advantage of anterior surgery is that it allows for a direct decompression of the compromised spinal canal. However, the potential for devastating long-term sequelae as a result of complications is high.
The aim of this study was to give a general overview and identify the incidence of vascular complications.
There is limited literature describing the overall incidence and complications of anterior spinal surgery.
A retrospective review of a prospective database of 1,262 consecutive patients with anterior surgery over a twelve-year period.
In our study, 1.58% (n=20) of patients suffered complications. Injury to a major vessel was encountered in 14 (1.11%) cases, of which nine involved an injury to the common iliac vein. In six cases, the original procedure was abandoned due to a life-threatening vascular injury (n=3) and unfavourable anatomy (n=3).
The incidence of vascular and other complications in our study was relatively low. Nevertheless, the potential for devastating long-term sequelae as a result of complications remains high. A thorough knowledge and awareness of normal and abnormal anatomy should be gained before attempting such a procedure, and a vascular surgical assistance especially should be readily accessible. We believe use of access surgeons is mandatory in cases with difficult or aberrant anatomy.
现代生物材料和器械已使经前路的胸腰椎手术得以普及。前路手术的优点是能够直接对受损的椎管进行减压。然而，并发症导致严重长期后遗症的可能性很高。
本研究的目的是进行总体概述并确定血管并发症的发生率。
描述前路脊柱手术总体发生率和并发症的文献有限。
对一个前瞻性数据库进行回顾性分析，该数据库包含连续12年接受前路手术的1262例患者。
在我们的研究中，1.58%（n = 20）的患者出现并发症。14例（1.11%）患者发生大血管损伤，其中9例涉及髂总静脉损伤。6例患者因危及生命的血管损伤（n = 3）和解剖结构不佳（n = 3）而放弃原手术。
我们研究中血管及其他并发症的发生率相对较低。尽管如此，并发症导致严重长期后遗症的可能性仍然很高。在尝试此类手术之前，应全面了解正常和异常解剖结构并提高认识，尤其应随时能够获得血管外科的协助。我们认为，在解剖结构困难或异常的情况下，必须使用入路外科医生。
