Complications of Multilevel Anterior Cervical Fusion

多節前位頸椎融合術之併發症

潘彥宏(Yan-Hong Pan) ； 鄭均洹(Chun-Yuan Cheng) ； 陳新源(Shin-Yuan Chen) ； 林瑞峰(Jui-Feng Lin) ； 邱琮朗(Tsrong-Laang Chiou) ； 陳武福(Wu-Fu Chen) ； 哈鐵木爾(Tomor Harnod) ； 蘇泉發(Chain-Fa Su) ； 宋英聖(Ying-Sheng Soong) ； 林欣榮(Shinn-Zong Lin)

《慈濟醫學雜誌》 16卷2期 (2004/04) Pp. 79-84

https://doi.org/10.6440/TZUCMJ.200404.0079

摘要

目的:雖然前頸椎融術對於大多數的前頸椎病灶已是種普通術式，多節前位頸椎融合手術的複雜性、高併發症及內咕定器使用之時機，令此種術式之進行仍是種挑戰。病人與方法: 由1994年6月到1999年6月間，共有49位患者接受多節前位頸椎融合術，神經減壓及骨融合的位置由臨床症狀及核磁共振的發現來決定。所有的病患均接受改良後的史密斯-羅賓森術式（modified Smith-Robinson procedure）及自體前腸骨頂取得的三面皮質骨融合。在接受三節或三節以上手術及頸椎不穩定的患者會加上內固定器。手術併發症之分析包括：取骨處疼痛、吞嚥困難、內固定器失敗、取骨處血腫及脊髓損傷。結果：共有36位患者（73.5%）接受二節融合、11位患者（22.4%）接受三節融合、2位患者(4%)接受四節融合、16位患者（32.6%）接受內固定器固定，所有的患者經過至少12個月的追蹤後，頸椎均已融合。手術併發症包括：在18位患者取骨處疼痛（36.7%）、16位患者短暫的吞嚥困難（32.6%）、4位患者內固定器失敗（8%）、1位患者取骨處血腫（2%）及1位患者脊髓損傷（2%）。結論：合併使用三面皮質骨及內固定器做前位頸椎多節融合術，雖然能得到很高的融合效果，卻有太高之罹病率。慎選病患以避免不必要之骨融合及內固定器之使用，可避免過高之罹病率。使用人工骨關節（cage），是可以考慮的另類選擇。

關鍵字

多節前位頸椎融合術 ； 併發症 ； 三面皮質骨融合

並列摘要

Objective: Although anterior cervical fusion is a standard procedure for most anterior cervical lesions, multilevel anterior cervical fusion with or without instrumentation remains a challenge due to the complexity of decision making and the high rate of complications as reported in the literature. Patients and Methods: During the period from June 1994 to June 1999, 49 cases of multilevel segmental anterior cervical fusion were retrospectively reviewed. Levels of fusion were determined mainly according to clinicalpresentations and related magnetic resonance imaging (MRI) findings. A modified Smith-Robinson surgical procedure and tricortical autogenous bone graft taken from the anterior iliac crest were used in all reviewed cases. Instrumentation was indicated only when there were 3 or more fusion levels, and/or when instability was documented. Complications including a painful donor site, transient dysphagia, instrumentation failure, hematoma formation, and spinal cord injury were analyzed. Results: Thirty-six patients (73.5%) received 2 levels of fusion, 11 patients (22.4%) received 3 levels of fusion, and 2 patients (4%) received 4 levels of　fusion. Sixteen of 49 (32.6%) patients received plate and screw fixation. All patients achieved solid fusion by at least the 12-month follow-up. Complications included a painful donor site in 18 patients (36.7%), transient dysphasia in 16 patients (32.6%), instrumentation failure in 4 patients (8%), donor site hematoma in 1 patient (2%), and spinal cord injury in 1 patient (2%). Conclusions: Although the fusion rate of multilevel segmental anterior cervical fusion can be maximized if an autogenous tri-cortical bone graft is used and the stability is reinforced with instrumentation, the morbidity remained high. Alternative fusion materials such as a cagewith or without an autogenous bone graft should be considered to avoid a painful donor site; meticulous surgical technique with intermittent retraction blade relaxation may decrease the incidence of dysphasia. Proper patient selection is important for avoiding unnecessary fusion levels and instrumentation.

並列關鍵字

anterior cervical fusion ； complication ； tri-cortical autogeneus bone graft