颈椎手术后脑脊液漏的原因和处理  

Causes and treatment of cerebrospinal fluid leakage after cervical spine surgery

作　　者：戚小忠 徐宏光[2] 赵泉来[2] 宋俊兴[2] 章平治[2] 胡斌[2] 李梓瑞[2] 

机构地区：[1]桐城市范岗镇华鑫医院骨科,安徽安庆231460 [2]皖南医学院附属弋矶山医院脊柱外科,安徽芜湖241001

出　　处：《皖南医学院学报》2014年第2期111-113,共3页Journal of Wannan Medical College

基　　金：国家自然科学基金项目(81272048);卫生部公益性行业专项基金项目(201002018);安徽省教育厅自然科学基金重点项目(KJ2010A320)

摘　　要：目的：探讨颈椎手术后脑脊液漏的原因及处理方法。方法：选择2006年3月～2012年12月皖南医学院附属弋矶山医院颈椎减压手术386例，对临床上有关治疗效果的数据进行观察与记录。结果：在386名患者中术后共发生脑脊液漏6例，其中男4例，女2例，前路4例，后路2例，年龄39～73岁，平均（56＆#177;14．51）岁。术后4例1～3 d发现脑脊液漏，2例第8～10天发现。2例采用切口旁引流，3例采用腰段蛛网膜下腔引流，1例采用加压包扎。所有病例均获随访，随访时间为10个月～2．5年，无切口感染及脑脊液囊肿形成。结论：颈椎术后并发脑脊液漏时，及时处理预后较好。脑脊液渗出较多时，可采用切口旁引流和蛛网膜下腔引流，渗出较少时，加压包扎。Objective： To investigate the causes and treatment approaches to cerebrospinal fluid leakage after cervical spine surgery .Methods：386 pa-tients,undergone cervical spine decompression in the Affiliated Yijishan Hospital of Wannan Medical College between March 2006 and December 2012, were included,and the clinical data were kept concerning the treatment effects .Results：The patients aged from 39 to 73 years old with an average of 56 ＆#177; 14.51 years.In 386 patients,6 were complicated with cerebrospinal fluid leakage（4 males and 2 females）,in whom 4 were associated with leakage after anterior incision and 2,posterior incision.The cerebrospinal fluid leakage occurred one to three days after the surgery in four cases,and 2 in 8 to 10 days. Two patients were treated with drainage next to the incision,3 with lumbar subarachnoid drainage,and 1 with pressure bandage.The total patients were followed up from 10 months to 2.5 years,and the results showed that no incision infection or cerebrospinal fluid cyst occurred .Conclusion：Timely inter-vention upon cerebrospinal fluid leakage can lead to better prognosis ,and relatively heavy leakage may be managed by neighboring drainage or subarach-noid drainage.Those with less leakage may be treated with pressure bandage.

关 键 词：颈椎 术后并发症 脑脊液漏 

分 类 号：R687.3[医药卫生—骨科学]