Lee Byung-Jou, Sohn Moon-Jun, Han Seong-Rok, Choi Chan-Young, Lee Dong-Joon, Kang Jae Heon
Department of Neurosurgery, Inje University Ilsan Paik Hospital, College of Medicine, Goyang, Korea.
J Korean Neurosurg Soc. 2013 Sep;54(3):225-31. doi: 10.3340/jkns.2013.54.3.225. Epub 2013 Sep 30.
Spinal dysraphism defects span wide spectrum. Wound dehiscence is a common postoperative complication, and is a challenge in the current management of cerebrospinal fluid (CSF) leaks and wound healing. The purpose of this study is to evaluate the risks of CSF-related morbidity in the surgical treatment of spinal dysraphism.
Ten patients with spinal dysraphism were included in this retrospective study. The median age of the cohort was 4.8 months. To assess the risk of CSF morbidity, we measured the skin lesion area and the percentage of the skin lesion area relative to the back surface for each patient. We then analyzed the relationship between morbidity and the measured skin lesion area or related factors.
The overall median skin lesion area was 36.2 cm(2) (n=10). The percentage of the skin lesion area relative to the back surface ranged from 0.6% to 18.1%. During surgical reconstruction, 4 patients required subsequent operations to repair CSF morbidity. The comparison of the mean area of skin lesions between the CSF morbidity group and the non-CSF morbidity group was statistically significant (average volume skin lesion of 64.4±32.5 cm(2) versus 27.7±27.8 cm(2), p<0.05). CSF morbidity tended to occur either when the skin lesion area was up to 44.2 cm(2) or there was preexisting fibrosis before revision with an accompanying broad-based dural defect.
Measuring the lesion area, including the skin, dura, and related surgical parameters, offers useful information for predicting wound challenges and selecting appropriate reconstructive surgery methods.
脊柱裂畸形缺陷范围广泛。伤口裂开是常见的术后并发症，也是当前脑脊液（CSF）漏和伤口愈合管理中的一项挑战。本研究的目的是评估脊柱裂畸形手术治疗中与脑脊液相关的发病风险。
本回顾性研究纳入了10例脊柱裂畸形患者。队列的中位年龄为4.8个月。为评估脑脊液发病风险，我们测量了每位患者的皮肤病变面积以及皮肤病变面积相对于背部表面的百分比。然后我们分析了发病率与测量的皮肤病变面积或相关因素之间的关系。
总体皮肤病变面积中位数为36.2 cm²（n = 10）。皮肤病变面积相对于背部表面的百分比范围为0.6%至18.1%。在手术重建过程中，4例患者需要后续手术修复脑脊液相关发病情况。脑脊液发病组与非脑脊液发病组之间皮肤病变平均面积的比较具有统计学意义（皮肤病变平均体积为64.4±32.5 cm²对27.7±27.8 cm²，p<0.05）。当皮肤病变面积达到44.2 cm²或在翻修前存在纤维化并伴有广泛的硬脑膜缺损时，脑脊液发病倾向于发生。
测量病变面积，包括皮肤、硬脑膜和相关手术参数，为预测伤口挑战和选择合适的重建手术方法提供了有用信息。
