中国医师协会骨科医师分会骨科循证临床诊疗指南：脊柱手术硬脊膜破裂及术后脑脊液渗漏的循证临床诊疗指南

Evidence-based clinical practice guidelines for the treatment of dural tears and the consequent cerebrospinal fluid leak during spine surgery

脊柱外科手术中发生硬脊膜破裂及脑脊液渗漏并不罕见。脑脊液渗漏会带来多种并发症，如假性脊膜膨出、皮下窦道及蛛网膜炎等，少数患者甚至需要接受翻修手术。不同脊柱疾病的硬脊膜破裂和脑脊液渗漏发生率也有所不同。后纵韧带骨化、脊柱翻修手术、多节段椎板切除术中硬脊膜破裂的风险更高。针对这一问题，临床医师采取了多种措施进行处理，包括平卧制动，使用硬脊膜补片、纤维蛋白胶、明胶海绵修复、腰椎引流、肌瓣填塞等。中国医师协会骨科医师分会指南编写工作组依据循证医学方法，针对临床不同情况制定了《脊柱手术硬脊膜破裂及术后脑脊液渗漏的循证临床诊疗指南》，着重关注9个临床问题，并依据文献证据等级给出相应的推荐等级。工作组希望本指南能够为医师的临床诊疗提供最佳的、有效的治疗方案，从而让患者获得最佳的康复效果。

Dural tears （ DT） and the consequent cerebral spinal fluid （ CSF） leak are not rare in spine surgeries- CSF leak can be troublesome, leading to pseudomeningocele, cutaneous CSF fistula, and meningitis- Revision surgery is unavoidable in some cases- The reported incidences of DT and CSF leak are different according to the various pathologies- Ossification of the posterior longitudinal ligament, revision spine surgery and multi-segment laminectomy have higher risks for DT- Various techniques have been described to manage this complication, such as bed rest, repair with dural substitutes, fibrin glue, gelatin sponge, lumbar drain, muscle flap, etc-Through objective evaluation of the evidence and transparency in the process of making recommendations, it is Chinese Association of Orthopaedic Surgeons′ goal to develop evidence-based clinical practice guidelines for the treatment of incidental DT and the consequent CSF leak during spine surgery- The current clinical guidelines focus on 9 clinical questions and the strength of recommendations were made based on the quality of the literature- The work group considers that this guideline recommendations aim to assist in delivering optimum, efficacious treatment and functional recovery from this complication.