颈前路后纵韧带骨化切除术并发脑脊液漏的处理及疗效分析

Management and outcomes of cerebrospinal fluid leakage after anterior resection of cervical ossification of posterior longitudinal ligament

中文关键词:  后纵韧带骨化症  颈椎  硬脊膜  脑脊液漏

英文关键词:Ossification of posterior longitudinal ligament  Cervical vertebrae  Dural  Cerebrospinal fluid leak

中文摘要:

  【摘要】 目的：探讨颈椎后纵韧带骨化症（ossification of　posterior longitudinal ligament，OPLL）患者经颈椎前路手术并发脑脊液漏的处理方法及临床疗效。方法：2008年1月~2012年1月，采用颈前路后纵韧带骨化切除术治疗颈椎OPLL患者126例，男89例，女37例；年龄46～72岁，平均61岁；病程3d～7年，平均4.2年。骨化物在矢状面上范围涉及1～3个椎体。术中发现11例患者合并硬脊膜骨化，其中7例术中发生硬脊膜破损（4例为硬脊膜撕裂，3例形成硬脊膜缺损）；115例未合并硬脊膜骨化患者中，4例发生硬脊膜撕裂。术中均采用明胶海绵覆盖及生物蛋白胶封堵，术后采用常压引流、卧床休息、预防感染及营养支持等方法综合处理，观察患者脑脊液漏情况及转归。结果：11例术中硬脊膜破损的患者术后均发生脑脊液漏，脑脊液漏发生率为8.7%（11/126），其中合并硬脊膜骨化患者术后脑脊液漏发生率为63.6%（7/11），未合并硬脊膜骨化患者术后脑脊液漏发生率为0.03%（4/115），两组比较差异有统计学意义（P<0.001）。经综合处理后，3例于术后3～5d内痊愈；8例患者切口愈合拔管后形成间隙性脑脊液囊肿，经反复穿刺抽吸、颈部环形加压包扎治疗，均于术后14～30d内痊愈，其中1例合并颅内感染，经腰大池置管持续引流加鞘内注射抗生素治疗痊愈。11例患者均获随访，随访时间为1～36个月，平均12.8个月，无神经症状加重及持续性头痛等后遗症发生，术后平均神经功能改善率为51.2％。结论：颈椎OPLL患者行颈前路手术术中易发生硬脊膜损伤，术中一期修复极为困难，术后脑脊液漏发生率高，应采取综合措施处理，以获痊愈。

英文摘要:

  【Abstract】 Objectives: To analyze　and evaluate the management and outcomes of cerebrospinal fluid(CSF) leakage after anterior resection of　cervical ossification of　posterior longitudinal ligament(OPLL)．　Methods: A retrospective analysis was performed on 126 patients suffering from OPLL and undergoing anterior decompression between January 2008 and January 2012. Among the patients, there were 89 males and 37 females, with an average age of 61 years(range, 46-72 years) and an average course of 4.2 years(range, 3 days-7 years). The　length of ossification meassured in the sagittal plane involved 1-3 vertebrae. Eleven cases were associated with dural matter　ossification, and 7 of them had dural tears or defects. However, only 4 cases developed dural tears among the rest 115 patients. Gelatin sponge　coverage and　fibrin glue　sealing were used to repair the dura matter during operation. Bed rest, drainage, nutritional support and antibiotics administration were adopted after surgery. Results:　All 11 cases suffering from dural tears or defects developed CSF leakage after operation. The overall incidence of　CSF leakage was 8.7%(11/126), which showed significant difference comparing with dural　ossification(63.6%, 7/11) group and no ossification group(0.03%, 4/115)(P<0.001). Three cases had CSF leakage healed within 5 days after operation, while 8 cases evolved into intermittent　CSF cyst. Circular pressure bandage, repeated aspiration　and insertion of a lumbar drainage　were used. All 8 patients recovered 14　to 30 days later after operation. After an average follow-up of 12.8 months(range 1 to 36 months), the average improvement rate of JOA score was 51.2％, and no neurological deficit or persistent headache remained. Conclusions: OPLL is prone to develop dural injury during cervical anterior surgery, which leads to high incidence of　CSF leakage, variety interventions should be undertaken.