CAJ | 학술논문

目的：评价延长引流时间在治疗脊柱后路手术脑脊液漏中的效果。方法回顾分析2009年1月至2012年3月我院脊柱外科后路手术2137例，其中术中发现硬脊膜损伤脑脊液漏157例，术后出现脑脊液漏患者68例；均采用延长引流时间的方法，术后5～7 d拔除引流管。根据硬脊膜损伤（ dural tear，DT）的部位和程度分为：硬脊膜暴露面的损伤（DT-1）、硬脊膜非暴露面的损伤（DT-2）、硬脊膜暴露面和非暴露面同时损伤（DT-3）、隐形硬脊膜损伤（DT-4）。分别采用直接无创缝合修复、直接缝合+耳脑胶或生物蛋白胶、明胶海绵+耳脑胶或生物蛋白胶、自体脂肪修复+明胶海绵+耳脑胶或生物蛋白胶等方法治疗。结果157例硬脊膜损伤中DT-1患者106例，DT-2患者18例，DT-3患者26例，DT-4患者7例。68例术后脑脊液漏中男43例，女25例，年龄23～59岁，平均（37.6±9.3）岁；其中DT-1患者30例，DT-2患者12例，DT-3患者19例，DT-4患者7例。59例患者术后第5天脑脊液漏出量小于200 mL，予以拔管后直接缝合，9例脑脊液漏出量大于200 mL延长至术后第7天予以拔管后直接缝合封闭引流口，引流口和切口均无脑脊液漏的发生，切口区域无皮下囊肿（硬脊膜假性囊肿）出现。脑脊液漏患者中有短期低颅压综合征症状者18例，切口均一期愈合。结论延长引流时间是治疗术后脑脊液漏的有效方法。
목적：평개연장인류시간재치료척주후로수술뇌척액루중적효과。방법회고분석2009년1월지2012년3월아원척주외과후로수술2137례，기중술중발현경척막손상뇌척액루157례，술후출현뇌척액루환자68례；균채용연장인류시간적방법，술후5～7 d발제인류관。근거경척막손상（ dural tear，DT）적부위화정도분위：경척막폭로면적손상（DT-1）、경척막비폭로면적손상（DT-2）、경척막폭로면화비폭로면동시손상（DT-3）、은형경척막손상（DT-4）。분별채용직접무창봉합수복、직접봉합+이뇌효혹생물단백효、명효해면+이뇌효혹생물단백효、자체지방수복+명효해면+이뇌효혹생물단백효등방법치료。결과157례경척막손상중DT-1환자106례，DT-2환자18례，DT-3환자26례，DT-4환자7례。68례술후뇌척액루중남43례，녀25례，년령23～59세，평균（37.6±9.3）세；기중DT-1환자30례，DT-2환자12례，DT-3환자19례，DT-4환자7례。59례환자술후제5천뇌척액루출량소우200 mL，여이발관후직접봉합，9례뇌척액루출량대우200 mL연장지술후제7천여이발관후직접봉합봉폐인류구，인류구화절구균무뇌척액루적발생，절구구역무피하낭종（경척막가성낭종）출현。뇌척액루환자중유단기저로압종합정증상자18례，절구균일기유합。결론연장인류시간시치료술후뇌척액루적유효방법。
Objective To evaluate the effect of prolonged drainage in remedying cerebrospinal fluid leakage after spinal surgery with posterior approach. Methods We retrospective analyzed 2 137 patients consecutively treated with posterior ap-proach in spinal surgery between Jan 2009 and Mar 2012. In which there were 157 patients with dura mater injury following with cerebrospinal fluid leakage and there was cerebrospinal fluid leakage after operation in 68 patients treating with prolonged drainage. The drainage tubes were extracted 5 to 7 days after surgery. According to the part and extent of spinal dura mater in-jury during operation,it could divided into five forms dural tear( DT). DT-1 showed injury in exposed side of dura mater. In DT-2,lesion located at non-exposed side. In DT-3,lesion existed at exposed and non-exposed side. In DT-4,the spinal dura mater whad deficiency. In DT-5,recessive spinal dura mater injury implied dura mater lesion did not found during operation but cerebrospinal fluid leak could be seen. Treatment methods included non-invasive suture directly,suture and pasted with Ear-brain glue( EC glue)or biological fibrin glue( BFG),repaired with gelatin sponge and pasted with EC glue or BFG,renovated with autogenous fat grafts and gelatin sponge and pasted with EC glue or BFG. Results There were 106 cases in DT-1,18 in DT-2,25 in DT-3,1 in DT-4,7 in DT-5 in 157 patients with spinal dura mater injury. There were 25 female and 43 male pa-tients with an average age of(37. 6 ± 9. 3)years(range:23~59)in 68 patients with cerebrospinal fluid leakage after opera-tion. And there were 30 cases in DT-1,12 in DT-2,18 in DT-3,1 in DT-4,7 in DT-5. No case was found cerebrospinal fluid ef-fusion around incision and drainage port after removing the drainage tube. No case with the dura mater pseudocyst was found. All incision healed by first intention. Conclusion Prolonged drainage is an effective ways of remedying cerebrospinal fluid leakage after posterior spinal surgery.