协和医学杂志

2014, v.5(02) 175-178

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脊柱外科非计划再次手术的原因
Causes of Unplanned Reoperations of Spinal Surgery

李晔;翁习生;沈建雄;仉建国;赵宏;赵宇;田野;胡建华;李书纲;于斌;王以朋;
LI Ye;WENG Xi-sheng;SHEN Jian-xiong;ZHANG Jian-guo;ZHAO Hong;ZHAO Yu;TIAN Ye;HU Jian-hua;LI Shu-gang;YU Bin;WANG Yi-peng;Department of Orthopedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

摘要(Abstract):

目的分析脊柱外科非计划再次手术的原因,为提高脊柱外科医疗服务质量提供客观依据。方法回顾性分析本院2012年2月至2013年7月脊柱外科住院行非计划再次手术患者的临床资料,对造成非计划再次手术的原因、患者术后转归、平均住院日和住院患者满意度进行分析。结果共22例脊柱外科患者行非计划再次手术,其中8例患者手术原因为螺钉位置欠佳,6例患者发生伤口愈合不良,7例患者出现术后肢体感觉和力量异常。通过调整螺钉位置、伤口清创和椎管探查、减压等手术方式可使患者获得相对较好的预后,但所涉及患者的平均住院日较同期未发生非计划再次手术的脊柱外科患者延长(25.6 d比12.5 d),住院患者满意度降低(85.2分比97.7分)。结论加强对非计划再次手术的监管非常重要。对单个学科非计划再次手术原因进行分析并提出预防措施,有利于提高该学科整体诊疗水平。
Objective To investigate the causes of unplanned reoperations of spinal surgery. Methods Patients hospitalized in the department of spinal surgery who underwent unplanned reoperations from February 2012 to July 2013 were retrospectively analyzed. The potential causes of unplanned reoperations were summarized. The postoperative outcome,average duration of hospital stay and satisfaction of these inpatients were also analyzed. Results A total of 22 patients underwent unplanned reoperations in the department of spinal surgery. Among these 22 patients,unplanned reoperations were performed due to unsatisfied pedicle screw placement in 8 cases,incision problems in 6 cases,and abnormal sensation or muscle strength in 7 cases. Adjustment of screw location,wound debridement,and spinal canal exploration / decompression yielded good outcomes. However,the average duration of hospital stay of these patients was longer than those without unplanned reoperations( 25. 6 d vs 12. 5 d) and the average inpatient satisfaction was lower( 85. 2 vs 97. 7). Conclusions Monitoring of unplanned reoperations is particularly important. The specific causes of unplanned reoperations in different departments should be carefully analyzed to inform the improvements.

关键词(KeyWords): 脊柱外科;非计划再次手术
spinal surgery;unplanned reoperation

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作者(Author): 李晔;翁习生;沈建雄;仉建国;赵宏;赵宇;田野;胡建华;李书纲;于斌;王以朋;
LI Ye;WENG Xi-sheng;SHEN Jian-xiong;ZHANG Jian-guo;ZHAO Hong;ZHAO Yu;TIAN Ye;HU Jian-hua;LI Shu-gang;YU Bin;WANG Yi-peng;Department of Orthopedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

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