首页 | 【重要提示】 | 期刊简介 | 编委会 | 在线投稿 | 期刊稿约 | 联系我们

石磊,陈德玉,史建刚,许国华,杨海松.颈椎前路手术中硬膜损伤的预防与治疗[J].脊柱外科杂志,2017,15(3):156-160.
颈椎前路手术中硬膜损伤的预防与治疗     点此下载全文 (Fulltext)
石磊  陈德玉  史建刚  许国华  杨海松
第二军医大学附属长征医院脊柱外科, 上海 200003
基金项目:
DOI:10.3969/j.issn.1672-2957.2017.03.006
摘要点击次数: 79
全文下载次数: 23
摘要:
      目的 探讨如何预防与治疗颈椎前路手术中出现的硬膜损伤。方法 回顾分析2011年10月-2015年10月在本院接受治疗的72例颈椎前路手术中硬膜损伤患者的临床资料。术中行明胶海绵、生物蛋白胶封堵30例,皮下筋膜组织覆盖缺损处加明胶海绵、生物蛋白胶黏合加固42例。其中32例术后48 h切口引流<200 mL/d,后续采用持续常压引流加弹力绷带适度绕颈环形加压的方法治疗;40例术后48 h切口引流>200 mL/d,后续采用腰大池引流结合弹力绷带适度绕颈环形加压的方法治疗。术后常规卧床,预防感染,营养支持治疗。结果 32例持续常压引流的患者恢复至脑脊液漏停止的平均时间为6.4 d,40例腰大池引流的患者平均恢复时间为11.2 d。所有患者术后神经功能均显著改善,切口愈合良好,无感染发生。仅1例发生颈前脑脊液假性囊肿,经反复穿刺抽吸加腰大池引流无效,于术后半年行颈椎前路囊肿切除修补术后痊愈。结论 充分的术前评估及熟练的手术技巧对于减少颈椎前路手术中硬膜损伤至关重要。对于已经形成的硬膜损伤,术中采取明胶海绵、生物蛋白胶封堵或皮下筋膜组织覆盖缺损处结合明胶海绵、生物蛋白胶黏合加固,再辅以术后伤口引流、腰大池引流等措施,可以取得满意疗效。
关键词:颈椎  硬膜下积液  手术中并发症  引流术
Prevention and treatment of dural injury during anterior cervical surgery    Fulltext
SHI Lei  CHEN De-yu  SHI Jian-gang  XU Guo-hua  YANG Hai-song
Department of Spinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
Fund Project:
Abstract:
      Objective To investigate the prevention and treatment of dural injury during anterior cervical surgery.Methods Data of 72 patients with dural injury during anterior cervical surgery from October 2011 to October 2015 were reviewed retrospectively.Gelatin sponge and fibrin glue were used to block 30 cases, and 42 cases were covered with subcutaneous fascia tissue, gelatin sponge and fibrin glue.Continuous normal pressure drainage and moderate compression around the neck with elastic bandage were adopted for 32 patients whose incision drainage was less than 200 mL/d in 48 h after operation.For 40 patients whose incision drainage was more than 200 mL/d in 48 h after operation, lumbar drainage and moderate compression around the neck with elastic bandage were adopted.The postoperative regular treatment included strict bed rest, preventing infection and providing nutritional support.Results The average recovery time of 32 patients who underwent continuous normal pressure drainage was 6.4 d.For the other 40 patients who underwent lumbar drainage, the average recovery time was 11.2 d.Neurological functions of all the patients were significantly improved after the operations.Wounds healed well without any infection.Cerebrospinal fluid pseudocyst occurred in one patient, for whom repeated puncture aspiration and lumbar drainage was not effective, finally he was cured by excision of pseudocyst and repair surgery in the sixth month after the anterior decompression.Conclusion Adequate preoperative evaluations and skilled surgical techniques are crucial to reduce dural injury during anterior cervical surgery.The satisfactory therapeutic effect for dural injury could be obtained by sealing dural tear with gelatin sponge and fibrin glue or covering dural defect with fascia, with reinforcement of gelatin sponge and fibrin glue, accompanied by postoperative incision drainage and lumbar drainage.
Keywords:Cervical vertebrae  Subdural effusion  Intraoperative complications  Drainage
HTML   在线阅读   查看全文  查看/发表评论  下载PDF阅读器

您是第826048位访问者

版权所有 © 脊柱外科杂志   沪ICP备08113909号

地址:上海市凤阳路415号长征医院骨科医院1楼 电子信箱:spinejournal@163.com
邮政编码:200003 电话:021-81885651 传真:021-63720099

本系统由北京勤云科技发展有限公司设计  京ICP备09084417号