退行性腰椎滑脱术后脑脊液漏的发生率及原因分析

Incidence and risk factors of cerebrospinal fluid leakage in surgical treatment of degenerative lumbar spondylolisthesis

目的：探讨退行性腰椎滑脱术后脑脊液漏的发生率及危险因素，为临床预防脑脊液漏的发生提供依据。方法：收集我院2008年1月～2014年12月收治的201例单节段退行性腰椎滑脱初次手术患者的病史资料，根据是否并发脑脊液漏分为观察组和对照组，分析患者的性别、年龄、吸烟史、饮酒史、是否合并糖尿病、体重指数（bodymassindex，BMI）、手术方式[腰椎后路椎间融合（PLIF）或经椎间孔椎间融合（TLIF）]、滑脱部位、滑脱程度（Meyerding分度）、手术时间及术者年资与术后脑脊液漏发生率的关系。结果：201例患者中共有20例并发脑脊液漏，发生率为9．95％（20／201）。单因素分析结果显示两组病例在手术方式、滑脱程度、手术时间、术者年资方面差异有统计学意义（P〈0．05）；多因素Logistic回归分析显示，手术方式（PLIF与TuF相比：OR=4．572，95％CI=I．192—17．534）、滑脱程度（I度滑脱与Ⅱ度及Ⅱ度以上滑脱相比：OR=0．172，95％CI=0．059。0．500）是退行性腰椎滑脱术后并发脑脊液漏的危险因素（P〈0．05）。结论：手术方式和滑脱程度影响退行性腰椎滑脱术后脑脊液漏的发生率。

Objectives： To evaluate the incidence of cerebrospinal fluid leakage（CSFL）, and to explore its risk factors in surgical treatment of degenerative lumbar spondylolisthesis. Methods： From January 2008 to December 2014, 201 patients undergoing primary surgery for degenerative lumbar spondylolisthesis eligible for this study were included. Data including age, gender, smoking history, alcohol use, diabetes, body mass index （BMI）, operation method [posterior lumbar interbody fusion （PLIF） or transforaminal lumbar interbody fusion （TLIF）], vertebrae of olisthy, degree of olisthy, operation time, surgeon＇s experience and presence of CSF leakage were collected by reviewing patients＇ medical records. Patients were divided into two groups according to the presence of CSF leakage. The relationship of these factors and the incidence of CSF leakage following degenerative lumbar spondylolisthesis surgery were analyzed. Results： The incidence of CSF leakage was 9.95%（20/201 cases）. Univariate analysis showed statistical differences in degree of olisthy, operation time and surgeon＇s experience（P〈0.05）. Multivariate logistic analysis showed operation method（PLIF vs TLIF： OR=4.572, 95% CI=1.192-17.534） and degree of olisthy （grade I vs grade I1 and above： OR=0.172,95% CI=0.059- 0.500） were risk factors of CSF leakage（P〈0.05）. Conclusions： Operation method and degree of olisthy affect the incidence of CSF leakage following lumbar spondylolisthesis surgery.