腰椎术中硬脊膜损伤及脑脊液漏的诊治策略进展

Management process of incidental durotomy and cerebrospinal fluid leakage following lumbar surgery:a literature review

硬脊膜损伤(incidental durotomy,ID)是腰椎手术中的常见并发症,由于常继发术后脑脊液漏,使该问题的临床治疗复杂而棘手。如果处理不当,可能导致切口不愈合、硬脊膜假性囊肿、颅内低压等诸多并发症,严重者可引起椎管内感染、脑膜炎而危及生命。笔者就ID的危险因素、发病机制、手术处理以及术后治疗策略进行分析总结,以期指导临床诊疗方案的制订。

Incidental durotomy(ID)is one of the most common intraoperative complications seen in spine surgery.Overall,incidental ID can occur in up to 17.0%.As cerebrospinal fluid leakage,postural headache,symptoms of low intracranial pressure,incision nonunion and many other problems may occur.Water-tight suture during operation is essential to ID management.More and more repair techniques have been applied with the advent of biomaterials such as fibrin glue,hydrogel and artificial dura mater.Subfascial drain is considered as safe and feasible,whereas there is no consensus on its usage and duration.Prophylactic antibiotic regimen is a routine practice postoperatively,but its standard application is worthy of thinking.Although late ambulation contributes to the alleviation of low intracranial pressure,prolonged bedrest seems not to reduce postoperative cerebrospinal fluid leakage,but increase the risk of bedrest-related complications.Thus,the management of ID is still controversial.ID may cause adverse impact on the postoperative rehabilitation,but it has not been shown to affect clinical outcomes after rigorous repair and effective postoperative treatment.