带蒂筋膜脂肪片修复椎管联合持续引流预防腰椎管狭窄症并硬脊膜损伤术后瘢痕粘连的效果观察

Effect of pedicled fascial fat sheet repairing spinal canal and continuous drainage on prevention of cicatricial adhesion following surgical treatment of lumbar spinal stenosis and dural injury

目的比较带蒂筋膜脂肪片修复椎管联合持续引流与硬脊膜修补联合透明质酸钠注射预防腰椎管狭窄症并硬脊膜损伤术后瘢痕粘连的效果。方法回顾性分析自2015-05—2018-05采用手术治疗的64例腰椎管狭窄症并硬脊膜损伤,32例采用带蒂筋膜脂肪片修复椎管联合持续引流预防硬脊膜粘连(观察组),32例采用硬脊膜修补联合透明质酸钠注射预防硬脊膜粘连(对照组)。比较2组手术时间、术中出血量、切口愈合时间、脑脊液漏发生率、并发症发生率,以及术后12个月狭窄节段椎管矢状径、狭窄节段硬膜囊面积、疼痛VAS评分、JOA评分。结果观察组与对照组手术时间、术中出血量差异无统计学意义(P>0.05);观察组切口愈合时间较对照组短,差异有统计学意义(P <0.05)。观察组术后无并发症发生,对照组术后7例脑脊液漏,4例切口深部感染,1例假性硬脊膜囊肿。与对照组比较,观察组术后脑脊液发生率、并发症发生率较低,术后12个月狭窄节段硬膜囊面积较大,差异有统计学意义(P <0.05)。2组术后12个月狭窄节段椎管矢状径、疼痛VAS评分、JOA评分差异无统计学意义(P>0.05)。结论腰椎管狭窄症并硬脊膜损伤术中采用带蒂筋膜脂肪片修复椎管联合持续引流能使伤口及时愈合,减少并发症的发生,可以更好地预防术后出现硬膜外瘢痕粘连。

Objective To compare the effect of pedicled fascial fat sheet repairing spinal canal with continuous drainage and dural repair combined with sodium hyaluronate injection to prevent scar adhesion following surgical treatment of lumbar spinal stenosis and dural injury.Methods A retrospective analysis of 64 lumbar spinal stenosis with dural injury treated from May2015 to May 2018 was conducted.Thirty-two cases were treated with pedicled fascial fat sheet to repair spinal canal and continuous drainage to prevent dural adhesion(observation group),while 32 cases were treated with dural repair combined with sodium hyaluronate injection to prevent dural adhesion(control group).The operation time,intraoperative hemorrhage,incision healing time,cerebrospinal fluid leakage rate,complication rate,and the sagittal diameter of spinal canal and dural sac area in narrow segment,VAS score of pain and JOA score 12 months after operation were compared between the two groups.Results There was no significant difference between the observation group and the control group in operation time and bleeding volume(P>0.05).The healing time of incision in the observation group was shorter than that in the control group(P<0.05).There were no complications in the observation group,while there were 7 cases of CSF leakage,4 cases of deep incision effusion and infection,and 1 case of pseudodural cyst in the control group.Compared with the control group,the incidence of cerebrospinal fluid and complications in the observation group was lower,and the area of dural sac in the stenosed segment was larger 12 months after operation,the difference was statistically significant(P<0.05).There was no significant difference in sagittal diameter of spinal canal in the stenosed segment,VAS score of pain and JOA score 12 months after operation between the two groups(P>0.05).Conclusion The pedicled fascial fat sheet combined with continuous drainage for treatment of lumbar spinal stenosis with dural lesions can make the wound heal in time,reduce the complications,and better prevent and reduce the occurrence of postoperative epidural scar adhesion.