Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
Spine (Phila Pa 1976). 2012 May 20;37(12):E702-7. doi: 10.1097/BRS.0b013e31824586a8.
Retrospective review.
To perform a single-institution analysis of incidence, treatment, and clinical outcome in patients with thoracic ossification of the ligamentum flavum (OLF) who experienced dural tears and cerebrospinal fluid (CSF) leakage.
There is a paucity of clinical reports focusing on dural tears and CSF leakage after thoracic OLF surgery. Because dural adhesion and dural ossification are common features of thoracic OLF, the incidence of CSF leakage in OLF patients is high and represents a significant clinical challenge.
A total of 266 patients with thoracic OLF were admitted to our hospital from 1995 to 2011. Each patient's medical records were reviewed to identify cases of dural tears and CSF leakage. Information on therapeutic strategy used to repair the dural tears and complications related to CSF leakage was extracted.
The incidence of dural tears and CSF leakage in OLF patients was 32% (85/266). The incidence of dural ossification was 25.2%. The dural tears were repaired with a range of materials, including gelatin sponge, muscle/fascia, artificial dura, silk suture, and fibrin glue. The intraoperative repair procedure did not resolve CSF leakage in 65 cases, and 16 of those cases experienced complications related to the continued CSF leakage, including CSF pseudocyst, wound dehiscence, and meningitis. Fifty-eight patients with CSF leakage were eventually cured by a series of comprehensive treatments, which included prone position, continuous pressure by sandbag, ultrasound-guided puncture, and aspiration. Only 7 patients required reoperation.
Dural ossification was the main reason for dural tears. In all, 78 of the 85 patients with CSF leakage or dural tear were successfully cured. The success rate was 91.8%, which indicated that a series of comprehensive treatments was an effective strategy to treat these patients.
回顾性研究。
对我院收治的胸段黄韧带骨化（OLF）术后并发硬脊膜撕裂和脑脊液（CSF）漏患者的发生率、治疗方法和临床转归进行分析。
目前鲜有关于胸段 OLF 术后并发硬脊膜撕裂和 CSF 漏的临床报道。由于胸段 OLF 常伴有硬脊膜粘连和硬脊膜骨化，OLF 患者的 CSF 漏发生率较高，是一个显著的临床难题。
1995 年至 2011 年，我院共收治 266 例胸段 OLF 患者。回顾性分析每位患者的病历资料，以识别硬脊膜撕裂和 CSF 漏病例。提取用于修复硬脊膜撕裂的治疗策略及与 CSF 漏相关的并发症等信息。
OLF 患者硬脊膜撕裂和 CSF 漏的发生率为 32%（85/266）。硬脊膜骨化发生率为 25.2%。采用明胶海绵、肌肉/筋膜、人工硬脊膜、丝线和纤维蛋白胶等多种材料修复硬脊膜撕裂。65 例患者术中修复后仍存在 CSF 漏，其中 16 例出现与持续 CSF 漏相关的并发症，包括 CSF 假性囊肿、伤口裂开和脑膜炎。58 例 CSF 漏患者经一系列综合治疗后痊愈，包括俯卧位、沙袋持续加压、超声引导下穿刺抽吸。仅 7 例患者需再次手术。
硬脊膜骨化是导致硬脊膜撕裂的主要原因。85 例 CSF 漏或硬脊膜撕裂患者中，78 例治愈，成功率为 91.8%，表明一系列综合治疗是治疗此类患者的有效策略。
