颈椎手术并发脑脊液漏的处理  

Management of cerebrospinal fluid leakage complicated in cervical surgery

作　　者：种衍学[1] 于晓川[1] 周建生[2] 

机构地区：[1]济宁医学院附属滕州市中心人民医院骨科,山东滕州277500 [2]蚌埠医学院附属医院骨科,安徽蚌埠233004

出　　处：《临床骨科杂志》2006年第6期537-539,共3页Journal of Clinical Orthopaedics

摘　　要：目的 探讨颈椎手术并发脑脊液漏（CSFL）的处理方法及其疗效。方法 对11例颈椎手术并发CSFL的患者，后路手术采用自体筋膜修补2例，前路手术采用自体筋膜明胶海绵堵塞9例，手术后仍存在CSFL患者采取去枕头高足低位、延长脱水剂应用时间、行腰穿蛛网膜下腔引流。结果 2例后路手术CSFL患者修补成功。9例前路行硬膜堵塞患者4例仍有CSFL，行腰穿蛛网膜下腔引流，切口引流或漏出0—3d停止．切口在引流后7d拆线均愈合。结论 CSFL术中采用修补或堵塞硬膜破口术后采用头高足低位、延长脱水剂应用时间可减少手术后CSFL的发生；术后持续腰穿蛛网膜下腔引流，能有效终止切口内CSFL，有利于切口愈合，避免感染发生。Objective To investigate the management and outcome of the cerebrospinal fluid leakage secondary to dural tear in cervical surgery, Methods 11 patients suffering from cerebrospinal fluid leakage during cervical operation were treated intraoperatively and postoperatively. Autologous fascia graft was used to repair the posterior wound of the dura mater in 2 cases. Autologous fascia graft as well as the absorbable gelatin sponge were used to block the anterior wound. Postoperatively, the patients who still had cerebrospinal fluid leakage underwent insertions of lumbar drains for draining CSF, lying at a position of head higher than feet and prolonged dehydration with drugs, Results 2 cases who underwent procedure for posterior surgical wound revision reveal no evidence of CSF leakage. 4 of 9 patients whose anterior wound was blocked still had cerebrospinal fluid leakage. The cerebrospinal fluid leakages were all ceased in 0 - 3 days after lumbar draining. Incisions were healed up 7 days post of lumbar draining. Conclusions Early identification of this complication , and closing or coverage of the dural tear with autologous fascia graft and the absorbable gelatin sponge and treatment with insertion of lumbar drain postoperatively can prevent the development of consequences.

关 键 词：颈椎/外科学 手术后并发症 脑脊液漏 引流术 

分 类 号：R687.3[医药卫生—骨科学] R615[医药卫生—外科学]