腰椎手术并发脑脊液漏的诊治进展

发布时间：2019-05-15 03:45

【摘要】：腰椎手术中硬脊膜损伤破裂是导致术后并发脑脊液漏的主要原因。腰椎手术术后要重点观察伤口渗出和引流量,并积极询问患者是否有头晕头痛等症状,以及早发现腰椎手术后并发脑脊液漏。符合以下条件即可做出腰椎手术并发脑脊液漏的诊断:1手术中明确有硬脊膜撕裂损伤或脑脊液漏;2术后伤口引流液为淡血性或清亮,引流量较大;3自伤口渗出淡血性或清亮的液体,量较大;4术后伤口皮下穿刺抽出淡血性或清亮液体;5患者术后头痛、头晕、呕吐,且与体位有关。腰椎手术中发现硬脊膜撕裂导致脑脊液漏,常用的补救方法是手术修补硬脊膜。对硬脊膜裂口较小的腰椎手术后脑脊液漏,可以采用持续脑脊液引流的方法治疗,效果满意。腰椎手术后并发脑脊液漏重在预防。手术医生术前应考虑到患者术中有发生硬脊膜撕裂的可能,并给予足够重视,术中使用高速钻头和咬骨钳时特别小心。
[Abstract]:The rupture of dural injury in lumbar spine surgery is the main cause of cerebrospinal fluid leakage after operation. After lumbar surgery, we should focus on wound exudation and drainage, and actively ask the patients if they have symptoms such as dizziness and headache, as well as early detection of cerebrospinal fluid leakage after lumbar surgery. The diagnosis of cerebrospinal fluid leakage in lumbar spine surgery can be made according to the following conditions: (1) dural tear injury or cerebrospinal fluid leakage can be clearly found in the operation, (2) the wound drainage fluid is hemorrhagic or clear after operation, and the drainage volume is large; (3) the amount of fresh or clear liquid exudated from the wound was large; (4) the wound was subcutaneously punctured and extracted with light blood or clear liquid; (5) the postoperative headache, dizziness and vomiting were related to the posture of the patients. Cerebrospinal fluid leakage caused by dural tear was found in lumbar surgery, and surgical repair of dura mater was commonly used. Continuous cerebrospinal fluid drainage can be used to treat cerebrospinal fluid leakage after lumbar surgery with small dural laceration, and the effect is satisfactory. Prevention of cerebrospinal fluid leakage after lumbar surgery. The surgeon should take into account the possibility of dural tear during operation and pay enough attention to it, especially when using high speed drill bit and bone forceps during operation.
【作者单位】：昆明医科大学第一附属医院;
【基金】：国家自然科学基金资助项目(81560366) 云南省医疗单位内设机构科研项目(2016NS021)
【分类号】：R687.3

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