腰椎翻修术并发脑脊液漏的原因分析及防治

目的:分析腰椎翻修术并发脑脊液漏的原因,并探讨其防治对策。方法:回顾性分析了2011年1月至2016年1月收治的135例行腰椎翻修术并发脑脊液漏的24例患者的临床资料。术中因瘢痕形成硬脊膜粘连严重分离时撕裂硬脊膜12例,黄韧带增生与硬脊膜重度粘连分离时撕裂硬脊膜4例。严重腰椎后纵韧带增生骨化与硬脊膜粘连,显露椎间盘时硬膜撕裂2例,置钉不当导致硬膜撕裂2例。其余4例在术中未见明显硬脊膜破损,在术后1~2 d发生脑脊液漏。且24例患者均采用了规范的术前、术中、术后的预防与处理措施。结果:24例发生脑脊液漏的患者经过治疗后均痊愈。其中20例获得了随访,时间6~30个月,均无脑脊液漏的复发及局部或全身并发症。结论:瘢痕形成是导致腰椎翻修手术出现脑脊液漏的主要原因。对于腰椎翻修手术,只要采取规范的防治措施,可显著降低脑液漏的发生率,同时取得较好的临床疗效,从根本上解决了长期困扰医患双方的脑脊液漏这一难题。

Causes prevention and treatment for cerebrospinal leak after lumbar revision surgery

Objective: To analyze the causes and explore the measures of prevention and treatment of the cerebrospinal leak after lumbar revision surgery. Methods: The clinical data of 24 patients(17.78%) with cerebrospinal leak among 135 cases after lumbar revision surgery from January 2011 to January 2016 was retrospectively studied. Of them,12 cases due to severe adhesion caused by scar formation;4 cases due to yellow ligament hyperplasia adhesion with dura mater occurred dural tears when separating adhesion;2 cases with severe hyperplasia and ossification of lumbar posterior longitudinal ligament occurred dural tears when revealing intervertebral disk;2 cases due to improper nailing happened dural tears during operation. And the other 4 cases without obvious dural tears in surgery,occurred cerebrospinal leak one to two days after surgery. And the 24 patients were treated with the measures of prevention and treatment preoperatively,intraoperatively,and postoperatively. Results: Twenty-four patients with cerebrospinal leak were cured after treatment and were follow-up for 6 to 30 months. No recurrence of cerebrospinal leake or local and systemic complications were found. Conclusion: Scar formation is the main cause of cerebrospinal leak in lumbar revision surgery. As for lumbar revision surgery,as long as the standard control measures are taken,it can significantly reduce the incidence of cerebrospinal leak,achieve better clinical efficacy,and fundamentally solve the cerebrospinal leak problem that has plagued both doctors and patients for a long time.