腰椎后路手术硬脊膜损伤和脑脊液漏的防治

目的:探讨腰椎后路手术硬脊膜损伤和脑脊液漏的处理方法。方法:回顾性分析2007年6月～2011年6月接受腰椎手术821例患者的资料。术中硬脊膜损伤或切开者56例,56例中术后有2例发生脑脊液漏。采用修复硬脊膜裂口、使用OB胶,严密缝合切口各层、头低脚高和伤口加压包扎等综合措施处理。观察并记录处理疗效。结果:所有患者获随访6个月～4年,平均2年1个月。术前症状获不同程度缓解。56例硬脊膜损伤和2例术后脑脊液漏患者均获临床治愈,无1例发生脑脊髓炎和脑脊液囊肿等并发症。结论:及时、正确地进行术中干预和术后处理,可有效治疗腰椎后路手术中硬脊膜损伤并预防术后脑脊液漏形成。

Prevention and treatment of dural tear sustained during an operation on the lumbar spine surgery and cerebrospinal fluid leakage

Objective To explore the treatment of dural tear sustained on the lumbar spine surgery and management of cerebrospinal fluid leakage.Method A retrospective research was designed and 821 patients with complete data who underwent the lumbar spinal surgeries were acquired between June 2007 and June 2011.A total of 56 cases of intraoperative dural injuries and durotomies were recorded.Cerebrospinal fluid leakage occurred in 2 cases of 56 patients.Surgical management included closure of breach in the dura mater,glued using medical OB glue,oversewing every layer of the wound,trendelenburg and compression dressing and so on.Clinical outcomes of surgical management were recorded.Results The average follow-up lasted for 2 years and 1 month(ranging from 6 months to 4 years).Preoperative symptoms remitted to different extents.There were 2 cases of postoperative cerebrospinal fluid leakage and 56 cases of intraoperative dural injuries which were cured ultimately.Conclusion Timely and correct surgical intervention and postoperative management can help to heal dural injuries in lumbar spinal surgeries and can prevent occurrence of postoperative cerebrospinal fluid leakage.