CAJ | 학술논문

目的：探讨老年腰椎椎管狭窄症患者手术发生硬膜囊撕裂的解剖学机制，比较撕裂位置及术中、术后处理对策。方法回顾性分析2012年01月～2014年01月本院行腰椎后路手术的216例＞70岁老年患者，记录患者一般资料、病程时间、术前诊断、手术方式和节段、术中硬膜囊撕裂的位置、术后脑脊液漏情况和处理方法以及并发症等。结果共计151例患者入选，其中男89例，女62例，年龄70～93岁，平均78．12岁。术中发生硬膜囊撕裂共计34例，术后出现脑脊液漏23例，硬膜囊撕裂位置发生率硬膜囊后外侧＞根袖＞硬膜囊外侧＞硬膜囊腹侧。术中采取硬膜囊缝合修补、明胶海绵压迫、生物蛋白胶粘合等处理，术后常规给予预防感染、神经根脱水、补液等治疗，均于术后3～10 d拔管，3～4周切口愈合，全部患者未出现严重并发症。结论＞70岁老年腰椎椎管狭窄症患者术中硬膜囊撕裂及术后脑脊液漏的发生率高于整体人群，且多位于硬膜囊后外侧及根袖，术中及时发现并仔细缝合或修补破损的硬膜、术后间断夹闭引流管、延长拔管时间能获得良好的效果。
목적：탐토노년요추추관협착증환자수술발생경막낭시렬적해부학궤제，비교시렬위치급술중、술후처리대책。방법회고성분석2012년01월～2014년01월본원행요추후로수술적216례＞70세노년환자，기록환자일반자료、병정시간、술전진단、수술방식화절단、술중경막낭시렬적위치、술후뇌척액루정황화처리방법이급병발증등。결과공계151례환자입선，기중남89례，녀62례，년령70～93세，평균78．12세。술중발생경막낭시렬공계34례，술후출현뇌척액루23례，경막낭시렬위치발생솔경막낭후외측＞근수＞경막낭외측＞경막낭복측。술중채취경막낭봉합수보、명효해면압박、생물단백효점합등처리，술후상규급여예방감염、신경근탈수、보액등치료，균우술후3～10 d발관，3～4주절구유합，전부환자미출현엄중병발증。결론＞70세노년요추추관협착증환자술중경막낭시렬급술후뇌척액루적발생솔고우정체인군，차다위우경막낭후외측급근수，술중급시발현병자세봉합혹수보파손적경막、술후간단협폐인류관、연장발관시간능획득량호적효과。
Objective To assess the anatomical mechanism , position, and surgical treatment of dural tear in elderly patients with lumbar spinal stenosis .Methods From January 2012 to January 2014, a total of 216 patients older than 70 years who underwent posterior lumbar interbody fusion due to lumbar spinal stenosis were retrospectively analyzed .The periop-erative data were recorded as general information , duration of the symptom , preoperative diagnosis , surgical procedures , posi-tion of dural tear and intraoperative treatment , postoperative cerebrospinal fluid leakage and treatment , and complications . Results Intraoperative dural tear occurred in 34 patients of 151 enrolled patients , 23 patients with postoperative cerebrospinal fluid leakage .The comparison of the incidence of dural tear position was posterior-lateral side of dural sac >root sleeve >lateral side of dural sac >ventral side of dural sac .All the torn dural sac were treated with dural sac suture , gelatin sponge oppression, or fibrin glue adhesion.A Combining the methods of tight suture closure of fascia and delayed extubation , all the cerebrospinal fluid leakage stopped 3-10 d postoperatively , and no severe complications were observed .Conclusion The incidence of dural tear in elderly patients over 70 years old was higher than the overall population .The majority of the dural tear occurred in the position of posterolateral dural sac and root sleeve .Tight suture closure of fascia and delayed extubation could be helpful in the treatment of postoperative cerebrospinal fluid leakage .