硬脊膜损伤分类及修复研究现状

Research status of dural injury types and repair

目的 对脊柱手术中或创伤后硬脊膜损伤分类和修复现状进行综述,为临床硬脊膜损伤修复及修复材料研发提供新策略与新思路。方法 广泛查阅近年国内外硬脊膜损伤相关文献,并进行分析和总结。结果 关于硬脊膜损伤已有大量回顾性研究,前瞻性和多中心研究较少,循证证据等级较低。硬脊膜损伤发生率和危险因素主要基于常见的颈腰椎退行性脊柱疾病相关研究,胸椎相关疾病研究不足。学术界亦尚未建立普遍认可的硬脊膜损伤分级和分类方法,这阻碍了其修复方法临床指南的制定。此外,尽管有新的材料和手术策略可用于解决针孔渗液和复杂部位硬脊膜损伤修复,但缺乏高级别临床研究和循证证据来验证其科学性和可靠性。结论 无论何种硬脊膜损伤,缝合仍是目前最重要修复方式;应进一步开发新型补片或密封剂以满足临床需求,降低修复难度。

Objective To evaluate the current status of classification and repair methods for dural injury causedby spinal surgery or trauma,providing new strategies and ideas for the clinical repair of dural injury and the developmentof related materials.Methods The literature related to dural injury both at home and abroad in recent years wasthoroughly reviewed and analyzed in order to draw meaningful conclusions.Results There have been numerousretrospective studies on dural injury,but there is a scarcity of prospective and multi-center studies,resulting in a low levelof evidence-based research.The incidence and risk factors of dural injury have primarily been studied in relation tocommon degenerative spinal diseases of the cervical and lumbar spine,with insufficient research on thoracic spine-relateddiseases.Currently,a universally recognized method for grading and classifying dural injury has not been established,which hampers the development of clinical guidelines for their repair.Furthermore,although there are repair materialsand surgical strategies available to address clinical issues such as suture leakage and surgical repair of dural injury incomplex locations,there is a lack of comprehensive clinical research and evidence-based data to validate their scientificityand reliability.Conclusion Regardless of the classification of dural injury,suture remains the most important repairmethod.It is important to further develop new patches or sealants that can meet clinical needs and reduce the difficulty ofrepair.