摘要
目的探讨腰椎术后迟发性硬脊膜撕裂(late presentation of dural tears,LPDT)所致脑脊液漏的发病及治疗方法,为临床管理患者提供新的思路及治疗方案。方法选取自2015年1月至2017年12月于我院腰椎组进行腰椎后路手术的患者,分析患者的一般信息和脑脊液漏情况,根据随访情况及复查情况分析并查找具有LPDT的患者及其治疗方式、并发症以及临床结局。结果共2359例腰椎术后患者纳入研究,脑脊液漏患者共43例(1.82%),术中或术后5天内出现的硬脊膜撕裂(dural tears,DT)伴脑脊液漏患者36例(1.53%),术中发现DT 23例(0.98%),LPDT所致脑脊液漏患者7例(0.30%),其中,2例分别于术后3周、4个月行局部清创+硬脊膜修补手术,5例经卧床休息保守治疗,5例恢复在良好及以上,2例恢复较差,而非延迟性脑脊液漏患者术后恢复未发生较差结局。结论术中未被识别的LPDT所致的脑脊液漏在脊柱术中是一个比较特殊的并发症,需要提高临床认识和予以恰当的治疗,对于有可疑症状的患者应当提高警惕,以帮助患者更好地恢复,减少长期后遗症。
Objective To investigate the incidence and treatment of cerebrospinal fluid leakage after delayed dural tear following lumbar surgery,and hope to provide new ideas and treatment opinions for its clinical management.Methods Patients after posterior lumbar surgery(Jan.2015-Dec.2017)were selected.General information,cerebrospinal fluid leakage features,follow-up results,reexaminations were analyzed to explore its treatment,complications and clinical outcomes.Results A total of 2359 patients were included in the study:43 patients(1.82%)with cerebrospinal fluid leakage;36 patients(1.53%)with intra or 5 days post-operation cerebrospinal fluid leakage after dural tear;23 patients(0.98%)with intra-operation dural tear;7 patients(0.30%)with cerebrospinal fluid leakage following delayed dural tear.Among the patients above,2 patients underwent local debridement and dural repair 3 weeks and 4 months after primary operation,5 patients were treated conservatively,5 patients achieved good recovery,and 2 patients had poor results.No poor outcomes occurred in patients with non-delayed cerebrospinal fluid leakage.Conclusions Non-identified cerebrospinal fluid leakage after delayed dural tear is a special complication in spine surgery.Surgeons should be on the alert for suspicious symptoms to achieve good recovery and reduce complications.
作者
王勇
杨枭雄
WANG Yong;YANG Xiao-xiong(Department of Orthopedics,Beijing North Hospital of the China North Industries Group Corporation,Beijing,100089,China)
出处
《中国骨与关节杂志》
CAS
2020年第4期259-264,共6页
Chinese Journal of Bone and Joint
关键词
腰椎
手术后并发症
脑脊液漏
硬脊膜撕裂
Lumbar vertebrae
Postoperative complications
Cerebrospinal fluid leak
Dural tear