Düsterwald K, Kruger N, Dunn R N
University of Cape Town.
Division of Orthopaedic Surgery, University of Cape Town.
S Afr J Surg. 2015 Dec;53(3 and 4):51-55.
Cervical spine injured patients often require prolonged ventilatory support due to intercostal paralysis and recurrent chest infections. This may necessitate tracheotomy. Concern exists around increased complications when anterior cervical spine surgery and tracheotomies are performed.
The primary aim of this study was to evaluate the effect of tracheostomy in anterior cervical surgery patients in term of complications. In addition, the aetiology of trauma and incidence of anterior surgery and ventilation in this patient group was assessed.
Patients undergoing anterior cervical surgery and requiring ventilation were identified from the unit's prospectively maintained database. These patients were further sub-divided into whether they had a tracheotomy or not. The aetiology of injury and incidence of complications were noted both from the database and a case note review.
Of the 1829 admissions over an 8.5 year period, 444 underwent anterior cervical surgery. Of the 112 that required ventilation, 72 underwent tracheotomy. Motor vehicle accidents, followed by falls, were the most frequent cause of injury. There was a bimodal incidence of tracheostomy insertion, the day of spine surgery and 6-8 days later. There was no difference in the general complication rate between the two groups. With regards to specific complications attributable to the surgical approach/tracheotomy, there was no statistically significant difference. The timing of the tracheotomy also had no effect on complication rate. Although the complications occurred mostly in the formal insertion group as opposed to the percutaneous insertion group, this was most likely due to selection bias.
Anterior cervical surgery and subsequent tracheostomy are safe despite the intuitive concerns. Timing does not affect the incidence of complications and there is no reason to delay the insertion of the tracheostomy. Ventilation in general is associated with increased complications rather than the tracheostomy tube per se.
颈椎损伤患者常因肋间肌麻痹和反复肺部感染而需要长期通气支持。这可能需要进行气管切开术。人们担心在进行颈椎前路手术和气管切开术时并发症会增加。
本研究的主要目的是评估气管切开术对颈椎前路手术患者并发症的影响。此外，还评估了该患者群体的创伤病因、前路手术发生率和通气情况。
从该科室前瞻性维护的数据库中识别出接受颈椎前路手术且需要通气的患者。这些患者进一步分为是否进行了气管切开术两组。从数据库和病例记录回顾中记录损伤病因和并发症发生率。
在8.5年期间的1829例入院患者中，444例接受了颈椎前路手术。在112例需要通气的患者中，72例进行了气管切开术。机动车事故是最常见的损伤原因，其次是跌倒。气管切开术的插入有双峰发生率，分别在脊柱手术当天和6 - 8天后。两组的总体并发症发生率没有差异。关于归因于手术入路/气管切开术的特定并发症，没有统计学上的显著差异。气管切开术的时机对并发症发生率也没有影响。尽管并发症大多发生在正式插入组而非经皮插入组，但这很可能是由于选择偏倚。
尽管存在直观的担忧，但颈椎前路手术及随后的气管切开术是安全的。时机不影响并发症发生率，没有理由延迟气管切开术的插入。一般来说，通气与并发症增加有关，而非气管切开管本身。
