摘要
目的探讨如何预防与治疗颈椎前路手术中出现的硬膜损伤。方法回顾分析2011年10月—2015年10月在本院接受治疗的72例颈椎前路手术中硬膜损伤患者的临床资料。术中行明胶海绵、生物蛋白胶封堵30例,皮下筋膜组织覆盖缺损处加明胶海绵、生物蛋白胶黏合加固42例。其中32例术后48 h切口引流<200 m L/d,后续采用持续常压引流加弹力绷带适度绕颈环形加压的方法治疗;40例术后48 h切口引流>200 m L/d,后续采用腰大池引流结合弹力绷带适度绕颈环形加压的方法治疗。术后常规卧床,预防感染,营养支持治疗。结果 32例持续常压引流的患者恢复至脑脊液漏停止的平均时间为6.4 d,40例腰大池引流的患者平均恢复时间为11.2 d。所有患者术后神经功能均显著改善,切口愈合良好,无感染发生。仅1例发生颈前脑脊液假性囊肿,经反复穿刺抽吸加腰大池引流无效,于术后半年行颈椎前路囊肿切除修补术后痊愈。结论充分的术前评估及熟练的手术技巧对于减少颈椎前路手术中硬膜损伤至关重要。对于已经形成的硬膜损伤,术中采取明胶海绵、生物蛋白胶封堵或皮下筋膜组织覆盖缺损处结合明胶海绵、生物蛋白胶黏合加固,再辅以术后伤口引流、腰大池引流等措施,可以取得满意疗效。
Objective To investigate the prevention and treatment of dural injury during anterior cervical surgery. Methods Data of 72 patients with dural injury during anterior cervical surgery from October 2011 to October 2015 were reviewed retrospectively. Gelatin sponge and fibrin glue were used to block 30 cases,and 42 cases were covered with subcutaneous fascia tissue,gelatin sponge and fibrin glue. Continuous normal pressure drainage and moderate compression around the neck with elastic bandage were adopted for 32 patients whose incision drainage was less than 200 m L/d in 48 h after operation. For 40 patients whose incision drainage was more than 200 m L/d in 48 h after operation,lumbar drainage and moderate compression around the neck with elastic bandage were adopted. The postoperative regular treatment included strict bed rest,preventing infection and providing nutritional support. Results The average recovery time of 32 patients who underwent continuous normal pressure drainage was 6.4 d. For the other 40 patients who underwent lumbar drainage,the average recovery time was 11.2 d. Neurological functions of all the patients were significantly improved after the operations. Wounds healed well without any infection. Cerebrospinal fluid pseudocyst occurred in one patient,for whom repeated puncture aspiration and lumbar drainage was not effective,finally he was cured by excision of pseudocyst and repair surgery in the sixth month after the anterior decompression. Conclusion Adequate preoperative evaluations and skilled surgical techniques are crucial to reduce dural injury during anterior cervical surgery. The satisfactory therapeutic effect for dural injury could be obtained by sealing dural tear with gelatin sponge and fibrin glue or covering dural defect with fascia,with reinforcement of gelatin sponge and fibrin glue,accompanied by postoperative incision drainage and lumbar drainage.
出处
《脊柱外科杂志》
2017年第3期156-160,共5页
Journal of Spinal Surgery
关键词
颈椎
硬膜下积液
手术中并发症
引流术
Cervical vertebrae
Subdural effusion
Intraoperative complications
Drainage
