颈椎后纵韧带骨化症前路改良手术预防脑脊液漏临床疗效观察  

Prevention and treatment of cerebrospinal fluid leak following anterior cervical corpectomy for ossified posterior longitudinal ligament

作　　者：黄俊俊[1] 贾连顺[1] 陈雄生[1] 

机构地区：[1]第二军医大学附属长征医院骨科 ,上海200003

出　　处：《浙江医学》2012年第14期1176-1179,共4页Zhejiang Medical Journal

摘　　要：目的探讨颈椎后纵韧带骨化症前路手术并发脑脊液漏的预防和处理。方法选取颈前路手术治疗后纵韧带骨化症患者315例，其中常规手术组80例，改良手术组235例。手术改良包括：使用头戴式照明工具，在双目放大镜下操作，后纵韧带钩辅助切除骨化韧带：硬脊膜骨化时，对双层骨化物利用未骨化韧带层分离后纵韧带骨化物并切除；对单层骨化物将骨化物连同硬脊膜一起切除但保留蛛网膜或将骨化物漂浮；术中脑脊液漏口用明胶海绵等封堵．纤维蛋白胶封闭，伤口常压置管引流24h；术后脑脊液漏者延长引流2～4d，伤口适当压迫。比较两组术后脑脊液漏及相关并发症的发生情况。结果常规手术组术中脑脊液漏14例（17．5％），改良手术组术中脑脊液漏16例（6．8％），差异有统计学意义（P〈O．01）。经术中、术后处理后所有脑脊液漏均得到治愈。改良手术组术后2例脑脊液漏经伤口压迫延长置管引流时间后治愈。常规手术组2例脊膜大块缺损出现持续性脑脊液漏，其中1例皮下脑脊液囊肿，抽吸1个月治愈，另1例经腰蛛网膜下腔引流7d治愈。结论改良手术可明显减少脑脊液漏的发生，术中明胶海绵等封堵漏1：3、术后延长伤口置管引流时间等保守治疗效果满意。术中大块脊膜缺损术后估计可能出现难治性脑脊液漏时，可以预防性采用腰蛛网膜下腔引流。Objective To investigate the prevention and management of cerebrospinal fluid leakage （CSFL）in patients with ossified posterior longitudinal ligament （OPLL） undergoing anterior cervical corpectomy. Methods Three hundred and fif- teen patients diagnosed as OPLL underwent anterio cervical corpectomy from January 1999 and December 2008; 80 cases re- ceived routine surgery and 235 cases received modified surgery. Surgical modification included resection of the ossification of posterior longitudinal ligament with assistance of a posterior longitudinal ligament hook under micro binocular Ioupe and sufficient illumination. When ossification of the posterior longitudinal ligament was associated with dural ossification （DO） and the OPLL was separated from DO through a thin layer consisting a nonossified degenerated posterior longitudinal ligament,OPLL was resected leaving the DO to avoid CSF leakage. Otherwise, the entire ossified mass including OPLL and DO was removed completely with the arachnoid membrane persevered. When entire ossified mass was difficult to remove, it was drilled paper thin and could grad- ually float anteriorly and did not compress the spinal cord eventually. Dura tear or dura defects were repaired with material such as gelatin sponge augmented by fibrin glue. Routinely closed drain was kept for 24h. When CSFL still persisted postoperatively,it extended for other 2-4d with local compression. Results The rate of CSFL in modified group was lower than that in routine group （6.8% vs 17.5%, x2=7.92, P 〈 0.01）. All CSFL were cured after intraoperative and postoperative treatment. There were 2 cases of continuous CSFL in postoperative period in routine group, of which one formed cerebrospinal fluid cyst and was cured after re- peated transdermal aspiration for 1 month; another case was cured with lumbar subarachnoid drain after 7d. Conclusion Modified surgical modality greatly decrease the rate of CSFL, of which CSFL were treated successfully with intraoperative using of gelatin sponge aug

关 键 词：颈椎 后纵韧带骨化症 脑脊液漏 手术 

分 类 号：R686.5[医药卫生—骨科学]