脊柱手术并发脑脊液漏的原因和治疗方式

Causes and treatment of cerebrospinal fluid leakage following spinal surgery

目的探讨脊柱手术发生脑脊液漏的原因及治疗方法。方法脊柱手术并发脑脊液漏48例,术中予硬脊膜缝合或取深筋膜修补,并用明胶海绵和生物蛋白胶封堵,无法缝合修补则使用封堵法;术后采用调整体位和控制脑脊液出量等保守治疗。结果脑脊液漏原因:硬脊膜切开4例,骨折脱位致硬脊膜损伤10例,分离硬脊膜粘连和手术操作损伤硬脊膜34例。术后仍有脑脊液漏41例,随访时间平均9月,48例脑脊液漏全部治愈,切口Ⅰ期愈合,无感染,无复发。结论医源性损伤是脊柱手术并发脑脊液漏的重要原因,术中硬脊膜经有效的缝合、修补或封堵,结合术后综合保守治疗脑脊液漏可以治愈,并可避免并发症发生。

Objective To analysis the cause of cerebrospinal fluid leakage in spinal surgery and to investigate its treatment. Methods A total of 48 cases of cerebrospinal fluid leakage following spinal surgery had been treated during January 2004 to January 2008. The average age was 48.3 years. Operations by anterior approach were in 8 cases and by posterior approach in 40 cases. The dura was sutured or repaired by deep fascia and blocked by gelatin sponge and biological protein. Conservative treatment was undertaken after operation including position adjustment and controlling cerebrospinal fluid, etc. Results Cerebrospinal fluid leakage was found elicited by spinal dura opening in 4 cases, fracture dislocation resulting in dural damage in 10 cases, dissecting spinal meningeal adhesion and inappropriate surgical procedure in 34 cases. Cerebrospinal fluid leakage still existed after operation in 41 cases. The average follow-up period was 9 months. All cases were cured at last and no recurrence. The incision healed primarily without infection. Conclusion Iatrogenic injury is an important cause inducing cerebrospinal fluid leakage in spinal surgery. Cerebrospinal fluid leakage can be cured by suture or repair of the dura and postoperative conservative treatment.