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退变性腰椎疾患后路减压术后脑脊液漏的相关因素分析及处理 被引量:26

Related factors and management of cerebrospinal fluid leakage during degenerative lumbar spine surgery
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摘要 目的:分析退变性腰椎疾患后路减压术后脑脊液漏的相关因素,探讨其处理方法。方法:收集2011年1月。2012年12月在北京大学第三医院骨科腰椎组手术治疗患者的病历资料,纳入因腰椎间盘突出症(LDH)、腰椎管狭窄症(LSS)、腰椎滑脱(LS)、腰椎退变性侧(后)凸(LDS)行腰椎后路减压术的患者,记录患者的性别、年龄、体重指数、诊断、是否翻修手术、手术方法、减压节段数、融合方式、术后引流量、引流管留置时间、脑脊液漏的诊断、术中及术后处理方法。按l:3配比选择对照组,观察脑脊液漏组术后引流特点和引流管留置时间。结果:共纳入因退变性腰椎疾患行后路减压手术治疗的患者1425例,其中男675例,女750例,年龄16~80岁,平均54.6±13.1岁。LDH378例,LSS647例,LS304例,LDS96例;初次手术1351例,翻修手术74例;1节段减压635例,2节段减压491例,3节段减压204例,4节段及以上减压95例。术后57例发生脑脊液漏,发生率为4.O%,其中LDH7例,发生率为1.9%;LSS30例,发生率为4.6%;LS13例,发生率为4.3%;LDS7例,发生率为7.3%。4种疾病脑脊液漏的发生率无显著性差异(P〉0.05)。翻修手术发生脑脊液漏9例,发生率为12.2%;初次手术发生脑脊漏48例,发生率为3.6%,差异有显著性(P〈0.05)。减压节段数4节段及以上者脑脊液漏的发生率为13.7%,高于1节段(1.9%)、2节段(3.7%)和3节段(6.9%)者。多因素Logistic回归分析结果显示翻修手术和减压节段数≥4是术后并发脑脊液漏的危险因素。脑脊液漏患者采用预防感染、体位调节、引流管留置平均5.6d,卧床休息6~7d.无一例出现伤口不愈合或感染,无一例形成脑脊液囊肿或瘘管,但引流量较对照组大。结论:翻修手术与减压节段数≥4是退变性腰椎疾患后� Objectives: To analyze the related factors of the cerebrospinal fluid leakage after degenerative lumbar spine surgery, and to investigate the correpondent management. Methods: From January 2011 to De- cember 2012, clinical and surgery records of patients undergoing spinal surgery in our institute were reviewed retrospectively. Pathogenesis included lumbar disc herniation(LDH), lumbar spinal stenosis(LSS), lumbar spondy- lolisthesis(LS) and lumbar degenerative scoliosis/kyphosis(LDS). Data of gender, age, body mass index(BMI), di- agnosis, revision surgery, surgical method, number of surgical levels, fusion method, amount of drain output, drain duration and management of cerebrospinal fluid leakage(CSFL) were collected. 3 cases as control without CSFL were randomly selected from the same database.
作者 张志平 郭昭庆 孙垂国 曾岩 李危石 齐强 陈仲强 ZHANG Zhiping, GUO Zhaoqing, SUN Chuiguo, et al//Chinese Journal of Spine and Spinal Cord, 2014, 24(10): 906-911
出处 《中国脊柱脊髓杂志》 CAS CSCD 北大核心 2014年第10期906-911,共6页 Chinese Journal of Spine and Spinal Cord
关键词 腰椎手术 并发症 硬膜撕裂 脑脊液漏 Lumbar spinal surgery Complications Dural tears Cerebrospinal fluid leakage
作者简介 男(1977-),副主任医师,研究方向:脊柱外科 郭昭庆E-mail:gzq6698@sina.com
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参考文献20

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