Narotam Pradeep K, José Sunil, Nathoo Narendra, Taylon Charles, Vora Yashail
Creighton University Medical Center, Division of Neurosurgery, Omaha, NE 68131, USA.
Spine (Phila Pa 1976). 2004 Dec 15;29(24):2861-7; discussion 2868-9. doi: 10.1097/01.brs.0000148049.69541.ad.
Retrospective review of 110 patients undergoing spinal dural repair and regeneration using an onlay, suture-free, 3-dimensional-collagen matrix graft (DuraGen) over an 8-year period (1995-2003).
Technique appraisal of collagen matrix to repair spinal dura following incidental durotomy, spinal tumor surgery, and trauma.
Traditional methods of spinal dural repair following incidental durotomy involve tedious attempts at primary watertight suture with a 5% to 10% failure rate. Dural injury occurs after trauma, or dural excision may be required after tumor resection. Collagen matrix is a newer development in collagen sponge.
The clinical and demographic data included diagnosis, type and site of surgery, infection risk, size of defect, use of lumbar drains, closed suction subfascial drains, and adverse events. The primary endpoints of graft failure were cerebrospinal fluid leak and pseudomeningocele formation. Neurosurgical wound infection rates were determined.
Collagen matrix was used (n = 110) in the following conditions: degenerative (69), pseudomeningocele formation repair (4), tumors (14), trauma (13), and congenital (5). There were 15 cervical (10 anterior), 21 thoracic (3 anterior), and 71 lumbar (all posterior) surgeries. Fibrin glue was used in 7.3%, subfascial drains in 82%, and lumbar drainage in 2.7%. Overall, cerebrospinal fluid leaks occurred in 2.7%. The 2 pseudomeningocele formations (3.2%) resolved at 3 months. There were 2 wound infections. In the subgroup with incidental durotomy (n = 69), failure of cerebrospinal fluid containment occurred in 4.3% [1 cerebrospinal fluid leak (1.4%), 2 pseudomeningocele formations (2.9%)].
Collagen matrix was successful in cerebrospinal fluid containment in > 95% of patients requiring dural repair following anterior and posterior spinal surgery. Subfascial drains were safe. Routine lumbar drains are not required but are recommended for repair of established pseudomeningocele formations.
对110例在1995年至2003年的8年期间接受使用覆盖式、免缝合、三维胶原基质移植物（DuraGen）进行硬脊膜修复和再生的患者进行回顾性研究。
对胶原基质在意外硬脊膜切开、脊柱肿瘤手术及创伤后修复硬脊膜的技术进行评估。
意外硬脊膜切开后传统的硬脊膜修复方法需要繁琐地尝试进行一期水密缝合，失败率为5%至10%。创伤后会发生硬脊膜损伤，或者肿瘤切除后可能需要切除硬脊膜。胶原基质是胶原海绵的一项新进展。
临床和人口统计学数据包括诊断、手术类型和部位、感染风险、缺损大小、腰段引流管的使用、皮下闭合吸引引流管以及不良事件。移植物失败的主要终点是脑脊液漏和假性脑脊膜膨出形成。确定神经外科伤口感染率。
胶原基质用于以下情况（n = 110）：退行性病变（69例）、假性脑脊膜膨出形成修复（4例）、肿瘤（14例）、创伤（13例）和先天性疾病（5例）。有15例颈椎手术（10例前路）、21例胸椎手术（3例前路）和71例腰椎手术（均为后路）。7.3%的患者使用了纤维蛋白胶，82%的患者使用了皮下引流管，2.7%的患者使用了腰段引流管。总体而言，脑脊液漏发生率为2.7%。2例假性脑脊膜膨出形成（3.2%）在3个月时消退。有2例伤口感染。在意外硬脊膜切开的亚组（n = 69）中，脑脊液封闭失败发生率为4.3%[1例脑脊液漏（1.4%），2例假性脑脊膜膨出形成（2.9%）]。
对于脊柱前后路手术后需要硬脊膜修复的患者，超过95%使用胶原基质成功实现了脑脊液封闭。皮下引流管是安全的。常规腰段引流管并非必需，但对于已形成的假性脑脊膜膨出修复建议使用。
