| 摘要: |
| 目的: 回顾性分析颈前路术后急性皮下血肿的临床特点及易发因素、预防措施。方法: 收集整理2004年12月至2008年12月1522例颈前路手术患者的临床资料，25例患者术后发生急性皮下血肿，男17例，女8例，年龄41～76岁，平均57.7岁，所有患者均先采取保守治疗，保守治疗无效时行二次手术探查，患者神经功能采用JOA评分进行评价。结果: 25例患者术后3～18.4h（平均7.7±3.2h）发生急性皮下血肿，发生率1.64%，6例患者经保守治疗有效，症状无恶化，术前JOA评分为11.5±1.9分，术后12.5±1.8分，术后2月14.2±1.0分，19例行二次手术探查患者，除1例死亡外，其余18例术后血肿症状及神经功能明显改善，入院时JOA评分为10.1±2.9分，出院时11.3±2.4分，术后2月为13.2±2.6分。结论: 急性皮下血肿发生迅速，但不会导致患者神经功能恶化，保守处理对部分患者有效，紧急开放切口、二次手术是皮下血肿主要治疗方法，其对神经功能没有负面影响。 |
| 关键词: 颈前路 并发症 血肿 二次手术 |
| DOI：10.3724/SP.J.1008.2010.0599 |
| 投稿时间：2009-05-12修订日期：2010-04-18 |
| 基金项目: |
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| Clinical Characteristics And Precautions of Acute Postoperative Subcutaneous Hematoma After Anterior Cervical Surgery |
| SHEN Xiao-long,YUAN Wen,WANG Xin-wei,ZHANG Ying,TANG Yong,TIAN Yie,CHAO Peng,LIN Qiu-shui,YUAN Wen |
| (Department of Orthopedics,Changzheng Hospital,Second Military Medical University ,Shanghai 200433) |
| Abstract: |
| [Abstract] Objective Retrospective analysis of clinical characteristics, potential risk factors and precautions of acute postoperative subcutaneous hematoma. Methods A retrospective analysis was done on 1522 cases ,who accepted anterior cervical surgery between Dec 2004 to Dec 2008. 25 cases developed postoperative subcutaneous hematoma after the operation, including 17 males and 8 female, with an average age of 67.7 years (range, 41～76 years). The secondary surgery was performed if conservative treatments were ineffective. Results 25 cases(1.64%) developed hematoma 3～18.4h (mean±SD, 7.7±3.2h) after the operation. In these patients, 6 cases who adopted conservative treatment received a better therapeutic effect, without further deterioration of the symptoms. Neurological function according to the JOA classification recovered from 11.5±1.9 preoperative to 12.5±1.8 postoperative, 14.2±1.0 two months postoperative. In 19 cases who suffered surgical evacuation, the clinical symptoms were markedly improved, except for 1 case of death. JOA score increased from 10.1±2.9 at admission to 11.3±2.4 at discharge, 13.2±2.6 two months postoperative. Conclusion The acute subcutaneous hematoma has a rapid progress, but does not lead to deterioration of neurological function. Conservative treatment may be effective in partial patients. The secondary surgery, the main treatment of the acute postoperative subcutaneous hematoma, should be done without hesitation if conservative treatments has no effect. It seems that the secondary surgery has no adverse effect on neurological function |
| Key words: anterior cervical surgery complication hematoma the secondary surgery |
