胸椎黄韧带骨化症手术并发硬脊膜损伤或脑脊液漏的原因分析及防治

The causes,prevention and therapy of dural injury or cerebrospinal fluid(CSF) leakage after operations on ossified ligamentum flavum in thoracic spine

目的:分析胸椎黄韧带骨化症(ossificationofligamentumflavum,OLF)手术并发硬脊膜损伤或脑脊液漏的原因,并探讨其防治方法。方法:对103例手术治疗的胸椎OLF患者中并发硬脊膜损伤或脑脊液漏病例的临床资料进行回顾性分析。结果:30例发生硬脊膜损伤,发生率为29.13%;22例术后发生脑脊液漏,发生率为21.36%,其中21例患者经以俯卧位为主的综合治疗后痊愈,1例发生伤口全层裂开,二次手术后痊愈。结论:硬脊膜损伤或脑脊液漏是胸椎OLF手术易发生的并发症;俯卧位为主的综合治疗是治疗术后脑脊液漏的有效方案,但患者较痛苦,有待改进。

Objective:To analyze the causes of dural injury or CSF leakage in the surgical treatment of OLF in the thoracic spine,and summarize the experience in the treatment and prevention.Method:Dural injury and CSF leakage in thoracic OLF cases treated surgically were studied retrospectively.Result:Dural injury occurred in 30 cases of 103(29.13%),22 cases appeared postoperative CSF leakage (21.36%).Among these 22 cases,21 were cured conservatively mainly with bed rest in the prostrate position,only one case′s incision splitted completely and were cured surgically.Conclusion:Dural injury or CSF leakage is a common complication of thoracic OLF operation;prostrate position is absolutely important in the postoperative management of CSF leakage.But this method still needs to be improved because of the pains it brings to the patients.