老年腰椎管狭窄症患者术中硬膜囊撕裂位置的分析

Analysis of Positions of Intraoperative Dural Tear in Elderly Patients with Lumbar Spinal Stenosis

目的探讨70岁以上老年腰椎管狭窄症患者术中常见的硬膜囊撕裂位置及其可能的发生机制。方法回顾性分析2012年1月—2014年1月70岁以上接受腰椎后路手术患者151例,其中行腰椎后路术中有硬膜囊撕裂34例的术中及术后处理方法。结果术中硬膜囊撕裂发生率为22.5%,17例位于硬膜囊后外侧,9例位于根袖,5例位于硬膜囊外侧,3例位于硬膜囊腹侧。结论 70岁以上老年腰椎管狭窄症患者术中硬膜囊撕裂发生率较高,位置常见于硬膜囊后外侧及根袖。应熟练掌握脊柱解剖结构、进行充分的术前评估及在术中精细操作。

Objective To explore positions of intraoperative dural tear in patients over 70 years of age with lum-bar spinal stenosis and the possible mechanisms. Methods Intraoperative and postoperative managements of 34 patients with cerebrospinal fluid leakage in 151 patients over 70 years of age with lumbar spinal stenosis undergoing posterior lum-bar interbody fusion during January 2012 and January 2014 were retrospectively analyzed. Results Incidence rate of in-traoperative cerebrospinal fluid leakage was 22. 5%. The positions of dural tear were 17 patients with posterior-lateral side of the dural sac, 9 patients with root sleeve, 5 patients with lateral side of the dural sac and 3 patients with ventral side of the dural sac. Conclusion The incidence rate of dural tear in patients over 70 years of age is high, and the main po-sitions are posterolateral dural sac and root sleeve. It is very important to be familiar with the anatomy of the spinal canal, and preoperative assessment and carefully intraoperative operation are recommended as well.