脊柱手术后脑脊液漏的治疗体会

Cerebrospinal Fluid Leakage after Spinal Surgery Treatment

目的总结脊柱手术后并发脑脊液漏的非手术治疗方法。方法回顾性分析广元市第四人民医院骨科脊柱手术后并发脑脊液漏19例患者的病例资料,其中男11例,女8例,年龄28～71(平均48)岁。其中胸腰椎前路肿瘤4例;胸腰椎后路:椎间盘摘除2例,椎管狭窄扩大减压3例,脊柱骨折5例。颈椎前路3例,后路2例。全部病例在术后采用头高脚底位,口服醋氮酰胺、淡盐水减少脑脊液分泌,控制蛛网膜下腔压力。颈椎前路3例采用硬膜外穿刺置管持续引流脑脊液,降低蛛网膜下腔压力。结果全部病例在5～14d拔管,伤口甲级愈合,无一例并发感染。出院随访6个月～2a,无并发头痛、腰痛,无硬脊膜囊肿。结论脊柱术后并发脑脊液漏可首选充分引流,降低蛛网膜下腔压力,胸腰椎后路促进硬膜裂口愈合,预防并发症等一系列非手术治疗措施,均可达到满意效果。

Objective Summary of cerebrospinal fluid leakage after spinal surgery Non-surgical treatment.Methods Retrospective analysis of our department of cerebrospinal fluid leakage after spinal surgery in 19 cases the medical records of patients,including 11 males and 8 females. Age 28 -71 years, mean 48 years. Anterior Spinal tumors in which 4cases,posterior thoracic and lumbar; disc removed in 2 case, 3 case of spinal stenosis decompression expansion,spinal fractures, 5 cases of anterior cervical in 3 cases. Posterior in 2. All records in the first post-operative use of high-pin low, oral acetazolamide, light salt water to reduce fluid secretion,control of subarachnoid pressure. 3cases of anterior cervical continuous drainage of cerebrospinal fluid lumbar puncture to reduce spinal pressure. Results All patients were extubated in 5-14 days, the wound healed well and no one complicated by infection. Discharge follow-up in June -2, the non-concurrent headache, back pain,no epidural cyst.Conclusions The full drainage can be the first choice after spinal cerebrospinal fluid leakage,reduce spinal pressure,promote healing of dural breach, prevent complications and a series of non-surgical treatments, can achieve satisfactory results.