脑损伤、颅内手术后出现腰、臀、骶尾、腿痛268例分析

Treatment analysis of 268 cases with the pain of waist, hips, sacral-coccygeal portion and thighs in post-operation of cerebral injuries

目的:探讨腰椎管穿刺放出血性脑脊液对脑损伤、颅内手术后出现的腰、臀、骶尾、腿疼痛的效果。方法:对脑损伤、颅内手术后出现腰、臀、骶尾、腿痛而颅内压不高或颅内压偏高,无脑脊液鼻漏、耳漏、颅内硬脑膜下无引流管的患者,做L4～5或L5～S1椎间隙穿刺,引流出血性脑脊液。每日穿刺放血性脑脊液1次,多次穿刺引流出血性脑脊液直至脑脊液基本清亮为止。结果:本组268例,经过多次腰椎管穿刺引流血性脑脊液,腰、臀、骶尾、腿痛全部消失。8例出现低颅压反应,经卧床休息,输生理盐水1000～2000ml/d,2～5d后低颅压反应消失。无一例出现严重并发症。结论:颅脑外伤、颅内手术后近期15d内出现的腰臀、骶尾及腿痛,主要是由血性脑脊液沉积于腰椎管内对腰、骶神经根或马尾神经产生的刺激而引起;腰穿放出血性脑脊液是有效的治疗方法。

Objective：To investigate the effects of draining hemorrhagic cerebrospinal fluid （CSF） through lumbar puncture on the pain of waist,hips,sacral-coccygeal portion and thighs in post-operation patients of cerebral injuries. Methods： 268 eases of post-operation cerebral injury patients with pain of waist, hips, sacral-eoecygeal portion and thighs, but without high intraeranial pressure or only with slightly high intracranial pressure;also without cerebrospinal rhinorrhea, eere- brospinal otorrhea,and without intracranial subdural drainage tube,were punctured through interspace of lumbar vertebrae 4 to 5 or lumbar vertebrae 5 to sacral vertebrae 1. Hemorrhagic CSF was drained out one time everyday until the CSF be- came clear. Results： Pain disappeared in all eases after drainage. Low intracranial pressure appeared in 8 of the 268 eas- es, which disappeared 2-5 days after staying in bed and after infusing saline solution 1 000-2 000 ml per day with no se- vere complications. Conclusion： Pain in waist, hips, sacral-eoccygeal portion and thighs 15 days after operation is mainly caused by irritation of hemorrhagic CSF on lumbar or sacral spinal nerve root, caudal nerve. Draining hemorrhagie CSF is an effective treatment method.