家兔胸腰段前侧脊膜损伤致脑脊液漏的预后与转归

Prognosis of cerebrospinal fluid leakage duo to thoracolumbar anterior dural injury in rabbit

目的:建立胸腰段脑脊液漏的动物模型,探讨胸腰椎前路手术后脑脊液漏的预后与转归。方法:32只家兔随机分为4组,每组8只,行胸腰前路手术,术中造成不同类型的脊膜损伤:A组,单纯线性切开脊膜0.5cm;B组,单纯线性切开脊膜1.0cm;C组,使脊膜缺损0.25cm2;D组,使脊膜缺损0.5cm2。均用明胶海绵及止血纱填塞脊膜缺损处,并用生物蛋白胶1支封闭,放置引流管,2d后拔除引流管,缝合引流口。术后30d行椎管造影CT扫描、美蓝灌注试验及病理学检查。结果:术后引流管均引流出脑脊液。A组术后第3天1只家兔死于肠梗阻;C组术后第7天1只家兔死于腹腔内化脓性感染;D组术后第2天1只家兔死于失血性休克,术后第6天1只家兔死于肠梗阻。术后30d时,A组脊膜均愈合;B组脊膜愈合4例,漏口缩小但未闭合2例,假性脊膜囊肿形成2例;C组脊膜愈合2例,漏口缩小但未闭合3例,假性脊膜囊肿形成2例;D组漏口缩小但未闭合5例,假性脊膜囊肿形成1例。各组造模切口上下1cm脊膜均可见淋巴细胞、浆细胞等炎性细胞浸润,脊膜变厚,可见非坏死性炎性浸润。结论:胸腰椎前路手术中脊膜损伤后小的线性切割伤可自行愈合,但大的片状缺损则难以自行修复。

Objective ：To establish the animal model of thoracolumbar cerebrospinal fluid（CSF） leakage and investigate the prignosis and result of CSF leakage due to thoracolumbar anterior dural injury in rabbit. Method：32 rabbits were randomly devided into four groups with 8 rabbits for each,different thoracolumbar dural injuries were made for each group by anterior thoracolumbar approach,including simple linear opening 0.5cm of dura （group A）,simple linear opening 1.0cm of dura （group B）,0.25cm^2 defect of dura （group C）, and 0.5cm： defect of dura （group D）.Gelfoam and hemostatic gauze were used to wad the dural leakage,and BFS was used too.Auto-iliac bone fusion was performed to the all animals.The tubes were pulled out and the orifices were sutured 2 days after surgery.CTM,methylene blue test,and dural matter pathology were examined on the 30 days of post-operation.Result：The CSF was seen in all drainage-tube in postoperation.1 rabbit died of intestinal obstruction 3 days after surgery in group A.1 rabbit died of abdominal pyogenic infection 7 days after surgery in group C.1 rabbit died of hemorrhagic shock 2 days after surgery and another died of intestinal obstruction 6 days after surgery in group D.30 days after surgery,all dural wounds healed in group A,4 cases wounds healed,2 cases shrinked,1 case had dural cyst in Group B,2 cases healed,3 cases shrinked,2 cases had the cyst in Group C, 5 cases shrinked.1 case with dural cyst in Group D.Thickening of dural matter,inflammatory cells infiltration mainly including lymphocytes and plasmocytes,and non-necrotic inflammatory infiltration were found around dural wound in all animal models.Conclusion：In anterior approach of thoracolumbar operation,CSF leakage can occure in case of dural injury.Small linear cut of dural matter can soon heal spontaneously,but huge defect or cut can hardly be completely repaired.