可吸收止血流体明胶预防术后脑脊液漏

Prevention of postoperative cerebrospinal fluid leakage with absorbable hemostatic fluid gelatin

目的 ：探索可吸收止血流体明胶预防术后脑脊液漏的有效性。方法 ：对2013年3月至9月有硬脊膜撕裂脑脊液漏的脊柱损伤17例患者进行回顾性分析,男16例,女1例;年龄16~67岁,平均（39.6±15.4）岁;颈椎1例,胸椎9例,胸腰段4例,腰椎3例;爆裂骨折4例,骨折脱位13例。神经损伤ASIA分级：A级12例,B级2例,D级2例,E级1例。车祸伤2例,高处坠落伤10例,重物砸伤4例,地震时从楼梯滚落1例。术中应用可吸收止血流体明胶封堵以预防术后脑脊液漏。记录术后每日的引流量。结果：17例患者有15例术后无脑脊液漏出现。2例术后出现脑脊液漏者引流管保留至术后第6~7天。术后未出现头痛、头晕、发热、颈项抵抗、皮疹、切口不愈合、切口感染、血肿、神经症状加重等并发症。随访9个月均未见到切口周围有异常现象。结论：术中应用可吸收止血流体明胶封堵硬脊膜撕裂预防术后脑脊液漏是有效的方法。

Objective：To explore the effectiveness of absorbable hemostatic fluid gelatin in preventing postoperative cerebrospinal fluid leakage. Methods：The clinical data of 17 patients with dura mater tear were retrospectively analyzed from March to September in 2003. There were 16 males and 1 female,aged from 16 to 67 years old with an average of（39.6±15.4）years. The injury site was at cervical vertebrae in 1 case,thoracic vertebrae in 9 cases,thoracolumbar junction in 4 cases,lumbar vertebrae in 3 cases. There were burst fracture in 4 cases and fracture dislocation in 13 cases. According to ASIA grade,12 cases were grade A,2 cases were grade B,2 cases were grade D,1 case were grade E. Two cases caused by traffic accident,10 by high falling,4 by heavy parts crash,1 by stairs fell during the earthquake. Absorbable hemostatic fluid gelatins were used to plug the dura mater tear,in order to prevent postoperative cerebrospinal fluid leakage. Postoperative drainage were recorded every day. Results：Of 17 patients,15 cases did not develop with cerebrospinal fluid leakage. Two cases develop with cerebrospinal fluid leakage after operation and their drainage were removed at 6 to 7 days after operation. In all cases,no complications related with cerebrospinal fluid leakage occurred,such as headache,dizzy,fever,neck resistance,rash,incision disunion,incision infection,hematoma,neurologic symptoms aggravation. No abnormal phenomena was found on incision surrounding at follow up of 9 months. Conclusion：Using absorbable hemostatic fluid gelatin to plug the dura mater tear during operation is an effective method in preventing postoperative cerebrospinal fluid leakage.