Thomsen Frederik, Amtoft Ole, Andersen Mikkel, Bøge-Rasmussen Torben, Jensen Tim Toftgaard, Jensen Lars Emil, Jespersen Stig, Kruse Anders, Thomsen Karsten
Privathospitalet, Hamlet A/S, Denmark.
Ugeskr Laeger. 2010 Mar 1;172(9):688-91.
Iatrogenic dural tear with cerebrospinal fluid leakage is a known complication of lumbar surgery of the columna. In the literature, the incidence is 3-16%.
The study was a retrospective, consecutive review of electronic patient records after spinal surgery at the Private Hospital Hamlet. The study covers cases from the 10-month period from September 1, 2007 to June 30, 2008. Data was collected after this period and consists of surgeon-documented dural tears. At the time of surgery, the surgeon was unaware that there would be a subsequent registration. A total of 634 patients had lumbar neural decompressive surgery - 479 patients were treated for spinal stenosis and 155 for prolapsed disc.
The incidence of dural tear was 3.9% (25 dural tears in 634 operations). The risk of a dural tear after secondary surgery was 7.9% versus 3.3% for primary (p = 0.02) and the mean age was 65.9 years for patients with dural tear compared with 58.1 years for patients without (p = 0.00). The difference in the mean duration of surgery was significant being 72 minutes in the group suffering a dural tear compared with 56 minutes (p = 0.03) among the remaining patients, and in the former group length of stay was increased by 1.1 day (p = 0.00).
The incidence of iatrogenic dural tear was 3.9%. The incidence of dural tear was doubled in secondary surgery. The duration of surgery increased by 16 minutes and the patients with dural tear were also hospitalized one day longer.
医源性硬脊膜撕裂伴脑脊液漏是脊柱腰椎手术中一种已知的并发症。在文献中，其发生率为3% - 16%。
本研究是对私立哈姆雷特医院脊柱手术后电子病历进行的回顾性连续分析。研究涵盖了2007年9月1日至2008年6月30日这10个月期间的病例。在此期间之后收集数据，数据包括外科医生记录的硬脊膜撕裂情况。手术时，外科医生并未意识到后续会有记录。共有634例患者接受了腰椎神经减压手术——479例患者因腰椎管狭窄接受治疗，155例因椎间盘突出接受治疗。
硬脊膜撕裂的发生率为3.9%（634例手术中有25例硬脊膜撕裂）。二次手术后硬脊膜撕裂的风险为7.9%，而初次手术为3.3%（p = 0.02），硬脊膜撕裂患者的平均年龄为65.9岁，无硬脊膜撕裂患者为58.1岁（p = 0.00）。硬脊膜撕裂组的平均手术时长与其余患者相比有显著差异，前者为72分钟，后者为56分钟（p = 0.03），且硬脊膜撕裂组的住院时间增加了1.1天（p = 0.00）。
医源性硬脊膜撕裂的发生率为3.9%。二次手术中硬脊膜撕裂的发生率翻倍。手术时长增加了16分钟，硬脊膜撕裂患者的住院时间也延长了一天。
