腰椎翻修术并发脑脊液漏的原因分析及防治
黄研生;张海平;牛兴邦;史少岩;郝定均
【期刊名称】《中国骨伤》 【年(卷),期】2017(030)009
【摘要】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 cas-es 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 pa-tients were treated with the measures of prevention and treatment preoperatively ,intraoperatively,and postoperatively. Re-sults:Twenty four patients with cerebrospinal leak were cured after treatment and were follow up for 6 to 30 months. No recur-rence 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 tak-en,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.%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1～2d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. 【总页数】4页(853-856)
【关键词】腰椎翻修术;脑脊液漏;防治 【作者】黄研生;张海平;牛兴邦;史少岩;郝定均
【作者单位】西安医学院,陕西 西安 710068;西安交通大学医学院附属红会医院脊柱外科,陕西 西安 710054;西安交通大学医学院附属红会医院脊柱外科,陕西 西安 710054;西安交通大学医学院附属红会医院脊柱外科,陕西 西安 710054;
西安交通大学医学院附属红会医院脊柱外科,陕西 西安 710054 【正文语种】中文 【中图分类】 【文献来源】
https://www.zhangqiaokeyan.com/academic-journal-cn_china-journal-orthopaedics-traumatology_thesis/0201219051516.html 【相关文献】
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腰椎翻修术并发脑脊液漏的原因分析及防治
