下腰椎后路手术并发脑脊液漏的处理

目的探讨下腰椎后路手术并发脑脊液漏的预防措施及处理。方法收集1999年1月-2004年6月259例下腰椎后路手术病例,腰间盘突出症174例,腰椎管狭窄症36例,腰椎滑脱症18例,腰椎间盘突出症失败再手术31例。术中发生硬脊膜损伤依次为8、5、2、6例,共计21例。术中采用硬脊膜破损口缝合术和明胶海绵封堵填塞法处理,术后采用侧俯卧头低腰高体位,引流管拔除时管口皮肤全层缝合,或经引流管口填塞明胶海绵 管口皮肤全层缝合及对症处理。结果21例中12例经术中及术后处理,切口1期愈合,未发生术后脑脊液漏(CSFL),9例术后发生CSFL,轻型2例、中型4例、重型3例。其中重型1例发生感染,其余8例术后9￣24d治愈。感染病例予以再次手术,再手术后第35d治愈。术后随访9￣31个月(平均16个月),全部病例未发生脑脊液囊肿形成,术后神经功能恢复良好。结论下腰椎后路手术发生CSFL,术中尽可能修复硬脊膜破损口并以明胶海绵填塞,术后采用头低腰高体位,适时拔除引流管并全层缝合管口皮肤等措施,可获得满意疗效。

The management of cerebrospinal fluid leakage complicated the posterior lower lumbar vertebral surgery

Objective To explore the prevention and management of cerebrospinal fluid leakage(CSFL) complicated in posterior route lower lumbar vertebral surgery.Methods 259 cases of posterior route lower lumbar vertebral surgery were collected from January 1999 to June 2004,that included lumbar disc herniation(174 cases),lumbar canal stenosis(36 cases),spondylolisthesis(18 cases)and failed lumbar disc herniation surgery syndrome(31 cases).The CSFL were arisen during operation 8,5,2and 6 cases respectively.The dural suture and gelfoma filling were done during operation,the methods were carried out,which included the patients position of cephalic low caudal high and drainage incision closure after the operation.Results 12 cases of 21 cases did not happen CSFL and the incision cured through out these measures as abova intra-operation and post-operation.Another 9 cases suffered CSFL after operation,8 cases of them were cured from 9 to 24 days by blocking wound with gelfoma and suturing the drainage wound.The rest 1 case got wound infection and had to do debridment and drainage once again,and it was cured in 35 days.The 9 cases were followed from 9 to 31 months,No one developed CSFL and neurological function damage.Conclusion As the CSFL complicated in posterior route lower lumbar vertebral surgery as possible repairing dural breakage and filling gelfoma in the wound as well as closing drainage wound in time,then adopt the patients position of cephalic low caudal high.These measures are verified in our experience.