脊柱术后并发脑脊液漏原因分析及预防

Cause analysis and prevention of cerebrospinal fluid leakage complicated with spinal surgery

目的通过汇总分析两院9年脊柱手术术后出现脑脊液漏原因及处理措施,总结脑脊液漏原因和正确处理方法。方法纳入两家医院骨科或神经外科出院时间为2010年1月1日-2019年3月1日患者700例脊柱手术患者,其中术后脑脊液42例,占6%。对出现脑脊液瘤患者术中情况、营养状况、硬脊膜破裂情况、留置引流管、脑脊液漏皮肤缝合方法、糖尿病病史等因素分析。出现脑脊液漏后分别给予深部缝合或常规方法缝合,根据缝合方法不同,分为观察组和对照组,收集资料,并进行统计学分析。结果出现脑脊液漏原因硬脊膜破裂、长期卧床、营养不良、糖尿病可导致脑脊液漏,通过深层缝合可明显提高脑脊液漏修补成功率。结论对于潜在脑脊液漏患者提早预防,发现脑脊液漏后局部深层缝合可明显提高脑脊液漏修补成功率。

Objective To summarize the causes and treatment of cerebrospinal fluid leakage after 9 years of spinal surgery in two hospitals.Methods 700 patients who underwent spinal surgery from January 1,2010 to March 1,2019 were admitted to the Department of Orthopaedic or Neurosurgery in two hospitals.Among them,42 patients(6%)had cerebrospinal fluid after spinal surgery.The operation condition,nutritional status,dural rupture,indwelling drainage tube,skin suture method for cerebrospinal fluid leakage and diabetic history of patients with cerebrospinal fluid tumors were analyzed.After cerebrospinal fluid leakage,deep suture or conventional suture were given respectively.According to different suture methods,the patients were divided into the observation group and the control group.Data were collected and analyzed statistically.Results The causes of cerebrospinal fluid leakage were dural rupture,long-term bed rest,malnutrition and diabetes mellitus,which could lead to cerebrospinal fluid leakage.Deep suture could significantly improve the success rate of repairing cerebrospinal fluid leakage.Conclusion Early prevention of potential CSF leakage can significantly improve the success rate of CSF leakage repair by local deep suture after CSF leakage.