术区持续引流至切口愈合时拔管缝合管口治疗脊柱骨折伴硬脊膜损伤术后脑脊液漏研究

Study of continuou wound drainage followed by catheter removing and wound closure when wound is completely healed in cerebrospinal fluid leakage induced by surgical operation of spinal fracture combined with dural injury

目的 探讨三种不同治疗方法在脊柱骨折伴硬脊膜损伤术后脑脊液漏治疗中的应用效果.方法 选择2009年8月-2014年8月收治的脊柱骨折伴硬脊膜损伤术后发生脑脊液漏患者89例作为研究对象,根据不同治疗方法分为A组（n=29）、B组（n=27）和C组（n=33）.A组给予体位调节伤口加压包扎治疗,B组给予经皮蛛网膜下腔置管脑脊液引流治疗,C组给予术区持续引流至切口愈合时拔管缝合管口治疗,比较三组患者的临床疗效.结果 C组初次成功率为100.00%,显著高于A组的62.07%和B组的70.37%,差异均有统计学意义（P〈0.05）;B组、C组并发症发生率、假性硬膜囊肿形成发生率均低于A组,差异均有统计学意义（P〈0.05）;C组脑脊液漏消失时间及切口愈合时间均低于A组和B组,差异均有统计学意义（P〈0.05）.结论 术区持续引流至切口愈合时拔管缝合管口治疗脊柱骨折伴硬脊膜损伤术后脑脊液漏疗效显著,缩短了脑脊液漏消失时间及切口愈合时间,减少了并发症及假性硬膜囊肿形成的发生,值得临床推广.

Objective To investigate the effect in the treatment of cerebrospinal fluid leakage in three different treatment methods of fracture with dural injury after spinal surgery induced by surgical operation of spinal fracture combined with dural injury, to provide the reference for the clinical treatment. Methods From August 2013 to August 2014, 89 patients of completely healed in cerebrospinal fluid leakage induced by surgical operation of spinal fracture combined with dural injury in our hospital were selected as the research object, according to the different methods of treatment were divided into A group （n=29）, B group （n=27） and C group （n=33）, The group A were received the treatment of posture adjustment of wounds bandaged, group B were received the treatment of percutaneous tube drainage of cerebrospinal fluid of subarachnoid catheter, group C were treated with prolonging wound drainage to the healing of incision of extubation suture pipe treatment, patients with clinical efficacy of the three groups. Results The success rate of group C was significantly higher than that for the first time in 100%, 62.07% in the A group and 70.37%in the group B, the difference was statistically significant （P〈0.05）; group B, group C, the incidence of complications, pseudomeningocele occurrence rate was lower than that of A group, the difference was statistically significant （P〈0.05）; group C cerebro spinal fluid leakage disappeared time and wound healing time were lower than those in group A and group B, the difference was statistically significant （P〈0.05）. Conclusion Prolonging wound drainage to the healing of incision of extubation suture pipe treatment of spinal fracture with dural injury postoperative cerebrospinal fluid leakage in a significant effect, shorten the disappearance time of cerebrospinal fluid leakage and wound healing time,reduce the formation and occurrence of complications and pseudomeningocele, it is worthy of attention.