Department of Orthopaedics, Paris-Saint-Joseph Hospital Group, 185 rue Raymond-Losserand, Paris, France.
Orthop Traumatol Surg Res. 2012 Dec;98(8):879-86. doi: 10.1016/j.otsr.2012.06.016. Epub 2012 Nov 15.
The dural tear is a dreaded complication of lumbar surgery.
Our management protocol has made it possible to deal with this problem effectively.
Retrospective review of 1359 patients operated between 2000 and 2010. In the event of dural tear, a therapeutic protocol was applied: suturing the dural wound if possible. A collagen patch lined with a layer of fibrin glue protected the suture. If the suture was considered tight, a non-aspirating drain was set up for 48h. In the other cases, no drain was set up. All the patients were left supine for 48h and they received intravenous antibiotics for the same duration. We analyzed the number and the type of breaches, the possibility of suturing, clinical symptoms (headache), and delayed complications (dural fistula or meningoceles).
The 1359 procedures included 23 dural tear complications (1.7%). The tears were often small in size and reparable. There were no late complications detected: no symptomatic fistula or meningocele. None of the patients had a second surgery.
This protocol provided effective management of dural tears in lumbar surgery, with no application problems. We suggest a number of improvements: the use of the Valsalva maneuver to test the suturing, a stand-up test for the patient, and a systematic late MRI to detect meningoceles. There is no reason to change the other points in the protocol: suturing, controlled drainage for watertight wounds, no drainage for the non-watertight wounds, antibiotics, and supine bed rest position 48h.
Level IV. Retrospective study.
硬脊膜撕裂是腰椎手术的一种严重并发症。
我们的治疗方案使得有效处理该问题成为可能。
回顾性分析 2000 年至 2010 年间接受手术的 1359 例患者。一旦发生硬脊膜撕裂，我们会应用治疗方案：如果可能，缝合硬脊膜伤口。胶原补丁覆盖一层纤维蛋白胶以保护缝合线。如果认为缝合紧密，可以放置非抽吸引流管 48 小时。在其他情况下，则不放置引流管。所有患者术后均保持仰卧位 48 小时，并接受静脉抗生素治疗相同时间。我们分析了裂口数量和类型、缝合可能性、临床症状（头痛）以及迟发性并发症（硬脊膜漏或脑脊膜膨出）。
1359 例手术中，有 23 例发生硬脊膜撕裂并发症（1.7%）。撕裂口通常较小且可修复。未发现迟发性并发症：无症状瘘或脑脊膜膨出。无患者行二次手术。
该方案为腰椎手术中的硬脊膜撕裂提供了有效的管理，且无应用问题。我们建议进行一些改进：使用瓦尔萨尔瓦动作测试缝合，对患者进行站立测试，以及系统的晚期 MRI 以检测脑脊膜膨出。没有理由改变方案中的其他要点：缝合、对密封伤口进行控制性引流、对非密封伤口不进行引流、使用抗生素以及术后保持仰卧位 48 小时。
IV 级。回顾性研究。
