人工硬脑膜联合自体脂肪组织治疗硬脊膜破裂的临床疗效研究

目的　比较人工硬脑膜联合自体脂肪组织与单纯人工硬脑膜修补治疗硬脊膜破裂的临床疗效。方法　收集2010年1月—2016年7月新疆医科大学第一附属医院收治的脊柱手术中硬脊膜破裂的30例脊柱疾病患者，根据手术方法将其分为单纯人工硬脑膜组（20例）和人工硬脑膜联合自体脂肪组（10例），单纯人工硬脑膜组患者采用传统手术方法，人工硬脑膜联合自体脂肪组采用在传统手术方法的基础上，将自体脂肪组织覆盖于人工硬脑膜表面。收集患者的一般资料，比较两组患者术后引流量、引流管放置时间、抗生素使用时间、住院时间及住院费用。结果　术后2、3 d人工硬脑膜联合自体脂肪组引流量均少于单纯人工硬脑膜组（P<0.05）。人工硬脑膜联合自体脂肪组术后1 d引流量多于术后2、3 d（t=15.060、28.460，P<0.001）；人工硬脑膜联合自体脂肪组术后2 d引流量多于术后3 d（t=7.041，P<0.001）。单纯人工硬脑膜组术后1 d引流量少于术后2、3 d（t=-9.235、-9.521，P<0.001）。人工硬脑膜联合自体脂肪组引流管放置时间、抗生素使用时间、住院时间均短于单纯人工硬脑膜组（P<0.05）；两组住院费用比较，差异无统计学意义（P=0.191）。结论　人工硬脑膜联合自体脂肪组织治疗硬脊膜破裂的临床疗效较好，可减少引流量、缩短引流管放置时间、抗生素使用时间。

Investigation of the Efficacy of Artificial Dura Mater Combined with Autologous Adipose Tissue Repair in the Treatment of Dural Rupture

Objective　To compare the efficacy of artificial dura mater combined with autologous adipose tissue and artificial dura mater alone in repairing dural rupture.Methods　Thirty patients with spine disease with dural rupture who were treated in the First Affiliated Hospital of Xinjiang Medical University between January 2010 and July 2016 were selected and divided into an artificial dura mater alone group（n=20） and an artificial dura mater combined with autologous adipose tissue group（n=10） according to the repair method used.The conventional repair method was used in the artificial dura mater alone group；in the artificial dura mater combined with autologous adipose tissue group，in addition to conventional treatment，the surface of the artificial dura mater was covered with autologous adipose tissue.The general patient data were collected，and the drainage volume after surgery，duration of drainage，duration of antibiotic treatment，number of days of hospitalization and cost were compared between the two groups.Results　The drainage volumes on the 2nd and 3rd day after surgery in the artificial dura mater combined with autologous adipose tissue group were both less than those in the artificial dura mater alone group（P<0.05）.In the artificial dura mater combined with autologous adipose tissue group，the drainage volume on the 1st day after surgery was more than that on the 2nd and 3rd day after surgery（t=15.060，28.460，P<0.001），and the drainage volume on the 2nd day was more than that on the 3rd day after surgery（t=7.041，P<0.001）.In the artificial dura mater alone group，the drainage volume on the 1st day after surgery was less than that on the 2nd and 3rd day after surgery（t=-9.235，-9.521，P<0.001）.The drainage duration，duration of antibiotic use and number of days of hospitalization were all shorter in the artificial dura mater combined with autologous adipose tissue group than those in the artificial dura mater alone group（P<0.05）.The hospitalization cost was not significantly different between the two groups（P=0.191）.Conclusion　Artificial dura mater combined with autologous adipose tissue repair is effective in treating dural rupture and can decreased drainage volume，shorten drainage time and reduce antibiotic use.