颈前路减压并发脑脊液漏手术治疗.pdfVIP

颈前路减压并发脑脊液漏手术治疗 张冬生，赵新华，杨永宏，楼肃亮，赵志芳 摘要 目的 探讨颈椎病前路减压并发脑脊液漏的手术治疗方式及其疗效。 方法 我科自 2008-08 至2010-04 共施行颈椎前路椎体次全切减压钛网植骨融合内固定手术246 例，术后 并发脑脊液漏6 例，此6 例术前均合并有明确的后纵韧带骨化。4 例术后1-3 天出现脑脊液 漏，2 例术后7 天出现脑脊液漏。此6 例经绝对卧床、补液、换药等对症支持治疗后，仍持 续存在脑脊液漏，其中1 例术后1.5 月仍有颈前脑脊液囊肿，经B 超检查明确为脑脊液漏。 本次6 例患者均再次行手术探查修补治疗，平均术后20 天再次行手术治疗。修补材料选用 骨腊、人工硬脑膜补片、纤维蛋白凝胶等。术后取低枕平卧位，常规应用抗生素抗炎、对症 支持治疗。 结果 经探查修补手术治疗后，6 例均治愈，切口 1 期愈合。术后随访 3-20 月（平均12 月）。全部病例无切口感染及脑脊液囊肿形成。术后神经功能恢复良好。 结论 对颈椎前路减压术后脑脊液漏经绝对卧床、对症支持治疗后效果不明显患者，手术探查人工 硬脑膜、纤维蛋白凝胶等修补治疗，疗效满意。 关键词 颈椎；脊柱融合术；术后并发症 Management of cerebrospinal fluid leakage complicated in anterior cervical surgery. ZHANG Dong-sheng,ZHAO Xin-hua, YANG Yong-hong,et al.Department of Orthopaedics,China PLA TH 117 Hospital,Hangzhou 310013,China. 【Abstract 】 Objective To investigate the operative method and outcome of cerebrospinal fluid leakage(CSFL) complicating anterior cervical surgery. Methods 246 patients were performed anterior cervical surgery between August 2008 and April 2010.Of 246 cases, 6 patients suffered from cerebrospinal fluid leakage after operation.All the patients had ossification of posterior longitudinal ligament(OPLL) before the operation. There were 4 cases of CSFL occurred after 1 to 3 days; 2 cases occurred after 7 days.All the 6 patients were treated by operation.The grafts include bone wax、synthetic collagen matrix graft、fibrin glue. Result All patients were followed up for 3 to 20 months (mean,12 months).No cerebrospinal fluid cyst and infection occurred.There were no significant negative effects of CSFL on the recovery of neuromuscular function. Conclusion CSFL following cervical anterior surgery can be cured by operative treatment using bone wax 、synthetic collagen matrix graft、fibrin glue. 【Key words 】Cervical vertebrae;Spinal fusion; Postoperative complications 脑脊液漏（cerebrospi