止血海绵覆盖治疗腰椎后路减压术中硬膜囊撕裂的临床疗效观察

Clinical efficacy of intraoperative hemostatic gauze covering teared dura meter in the treatment of cerebrospinal fluid leakage during lumbar spine surgery

中文关键词:  腰椎后路手术  脑脊液漏  止血海绵  临床疗效

英文关键词:Posterior lumbar surgery  Cerebrospinal fluid leakage  Hemostatic sponge  Clinical efficacy

中文摘要:

  【摘要】 目的：观察止血海绵覆盖治疗腰椎后路减压术中硬膜囊撕裂导致显性脑脊液漏的临床疗效，探讨其治疗硬膜囊撕裂的疗效。方法：回顾性分析2014年1月～2016年6月在我院行后路腰椎手术治疗的1896例患者资料（初次手术1850例，翻修手术46例），术中发现硬膜囊撕裂86例（初次手术78例，翻修手术8例），其中男35例，女51例，年龄18~72（53.8±8.3）岁，所有硬膜囊破口术中均行缝合修补。根据是否适用止血海绵覆盖分为两组，A组（46例）术中使用止血海绵覆盖硬膜囊联合明胶海绵加压处理缝合后的硬膜囊破口，B组（40例）术中常规皮下深筋膜覆盖硬膜囊联合明胶海绵覆盖加压处理缝合后的硬膜囊破口。收集患者一般资料、疾病类型、手术时间、硬膜囊撕裂长度、术中失血量，记录两组患者术后脑脊液漏的发生率及其每日引流量、引流管留置时间、起床活动时间、术后脑脊液漏早期并发症情况。术后出现脑脊液漏患者末次随访均复查腰椎MRI，观察术后脑脊液漏远期并发症，是否形成硬膜囊假性囊肿或脑脊液窦道形成。结果：A组与B组之间性别、年龄、疾病类型、术中硬膜囊撕裂大小、手术时间、术中失血量无统计学差异（P＞0.05），A组术后脑脊液漏发生率15.2%（7/46）低于B组35.0%（14/40），两组间有统计学差异（P＜0.05）；A组中术后出现脑脊液漏患者引流管留置时间（3.5±1.3d）及平均每日脑脊液引流量（125.0±59.3ml）明显低于B组（10.5±2.1d；329.0±103.1ml），两组间有统计学差异（P＜0.05）；A组中术后出现脑脊液漏患者起床活动时间7.5±1.6d，B组为14.5±2.2d，两组间有统计学差异（P＜0.05）；末次随访时A组出现低颅压性头痛（2/7）、切口渗漏不愈（0/7）、切口感染（0/7）等早期脑脊液漏并发症低于B组（8/14、2/14、1/14）（P＜0.05）。术后出现脑脊液漏患者术后随访复查腰椎MRI，A组未见明确硬膜外脑脊液囊肿或皮下窦道形成，B组存在硬膜外脑脊液囊肿1例，无皮下脑脊液窦道形成。结论：应用止血海绵覆盖硬膜囊治疗后路腰椎减压术中硬膜囊撕裂导致的显性脑脊液漏有效，可减少脑脊液漏引流管留置时间及引流量，降低术后脑脊液漏的发生率及其相关的早期并发症。

英文摘要:

  【Abstract】 Objectives: To observe the clinical effect of hemostatic sponge covering teared dura meter in the treatment of cerebrospinal fluid leakage during lumbar posterior decompression. Methods: From January 2014 to June 2016, clinical and operative records of 1896 patients undergoing spinal surgery in our institute were reviewed retrospectively. Among them, 86 cases of dural tear were found in the posterior decompression, including 35 males and 51 females with an average age of 53.8±8.3 years old, and all the dural tears were repaired. There were 46 patients in group A using hemostatic gauze with gelatin sponge covering pressure. 40 patients in group B using deep fascia covering dural sac combined with gelatin sponge covering pressure treatment. Gender, age, diagnosis, operation time, length of dural tear and intraoperative blood loss were collected. Incidence of cerebrospinal fluid leakage after surgery, drain output, drain duration, time of getting up and the early complications were collected. All patients with cerebrospinal fluid leakage were re-examined with lumbar MRI at the last follow-up to observe long-term complications and dural cyst, pseudocyst or cerebrospinal fluid sinus. Results: There was no significant difference between the experimental group and the control group in gender, age, diagnosis, the size of dural tear, operation time or intraoperative blood loss(P>0.05). The incidence of cerebrospinal fluid leakage in group A was 15.2%(7/46), which was lower than that in group B 35%(14/40), P＜0.05. The drainage tube indwelling time(3.5±1.3d) and the average daily cerebrospinal fluid drainage volume(125.0±59.3ml) in the experimental group were significantly lower than those in the control group(10.5±2.1d; 329.0±103.1ml), the differences were statistically significant(P＜0.05). Time of getting up for patients in the experimental group(7.5±1.6d) significantly earlier than that in the control group(14.5±2.2d), with statistically significant difference(P＜0.05); postoperative intracranial pressure headache(2/7), healing of incision leakage(0/7), wound infection(0/7) and other early complications of cerebrospinal fluid leakage were lower than those in the control group(8/14, 2/14, 1/14), P<0.05. The follow-up of patients after surgery in group A revealed no cerebrospinal fluid cyst or subcutaneous fistula formation, while in group B there was 1 case of epidural cerebrospinal fluid cyst, there was no subcutaneous CSFL sinus formation. Conclusions: The application of hemostatic sponge dura combined with gelatin sponge compression treatment for cerebrospinal fluid leakage in posterior lumbar decompression is effective. It can reduce the time of drainage, flow of cerebrospinal fluid leakage, the incidence of cerebrospinal fluid leakage after operation and the related early complications.