颈椎手术发生脑脊液漏的多因素分析  

Multiple factor analysis of cerebrospinal fluid leakage related to cervical spine surgery

作　　者：王自强[1] 林斌[2] 高春林[2] 张小雷[2] 杨枭雄 宋科冉[2] 任东风[2] 唐家广[2] 

机构地区：[1]锦州医科大学解放军总医院第一附属医院研究生培养基地,100048 [2]解放军总医院第一附属医院骨科,100048

出　　处：《中国脊柱脊髓杂志》2017年第4期305-311,共7页Chinese Journal of Spine and Spinal Cord

基　　金：北京市科技计划项目(项目编号:D161100002816003)

摘　　要：目的 :探讨颈椎手术发生脑脊液漏的危险因素,为临床预防脑脊液漏的发生提供依据及处理措施。方法:回顾性分析2013年1月~2016年12月接受颈椎手术的514例患者的临床资料,选择性别、体重指数、病程、吸烟史、饮酒史、高血压、糖尿病、颈椎骨折、颈椎间盘突出、颈椎管狭窄、骨质增生、后纵韧带骨化、黄韧带肥厚、硬脊膜粘连、手术入路、手术节段16个可能对发生脑脊液漏有影响的因素,应用多因素Logistic回归分析,研究其与脑脊液漏发生的相关性,并探讨其发生原因及处理措施。结果:514例患者中25例发生脑脊液漏,经过术中修补或术后对症处理,2~15d后患者脑脊液不再漏出,未出现严重并发症。颈椎术后脑脊液漏的整体发生率为4.9%,其中合并硬脊膜粘连的脑脊液漏发生率(38.1%)最高。多因素Logistic回归分析显示,硬脊膜粘连、后纵韧带骨化、骨折、狭窄与脑脊液漏的发生具有显著相关性(P<0.05)。结论:硬脊膜粘连、后纵韧带骨化、颈椎骨折和颈椎管狭窄是发生脑脊液漏的危险因素,需要根据不同的患病特点选择相应的处理措施来预防和应对脑脊液漏的发生。Objectives： To explore the risk factors of cerebrospinal fluid leakage in cervical spine surgery, and to provide basis and interventions for clinical prevention of cerebrospinal fluid leakage. Methods： Retrospective analysis was made on the clinical data of 514 patients who had cervical spine surgery from January 2013 to December 2016, for patients with cerebrospinal fluid leakage, gender, the BMI, course of disease, history of smoking, drinking, hypertension, diabetes, fracture, cervical disc herniation, cervical spinal canal stenosis, bone hyperplasia, ossification of posterior longitudinal ligament, hypertrophy of flavum ligament, adhesion of spinal dura, surgical approach, and surgical levels, a total of 16 factors which might affect the occurrence of cerebrospinal fluid leakage were documented. Logistic regression analysis was used to investigate the correlation with cerebrospinal fluid leakage, furthermore, its causes and interventions were also explored. Results： Among 514 cases, 25 cases suffered from cerebrospinal fluid leakage, after intraoperative repair or postoperative treatment, the cerebrospinal fluid was no longer leaking after 2-15d, no serious complications occurred, with the incidence rate of 4.9%. Adhesion of spinal dura had the highest incidence of cerebrospinal fluid leakage（38.1%）. Multiple factors Logistic regression analysis showed that adhesion of spinal dura, ossification of posterior longitudinal ligament, fracture, and cervical spinal canal stenosis were significantly associated with the incidence of cerebrospinal fluid leakage（P〈0.05）. Conclusions： Adhesion of spinal dura, ossification of posterior longitudinal ligament, fracture, and cervical spinal canal stenosis are the risk factors for postoperative cerebrospinal fluid leakage, it is necessary to take the corresponding treatment to prevent and respond to the occurrence of cerebrospinal fluid leakage.

关 键 词：颈椎手术 脑脊液漏 多因素分析 处理措施 

分 类 号：R619[医药卫生—外科学]