Ito Kiyoshi, Aoyama Tatsuro, Horiuchi Tetsuyoshi, Hongo Kazuhiro
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
J Neurosurg Spine. 2015 Dec;23(6):812-9. doi: 10.3171/2015.3.SPINE141215. Epub 2015 Aug 28.
The nonpenetrating titanium clip has been successfully used in peripheral arterial bypass surgery. The purpose of this study was to evaluate the leakage pressures and patterns of nonpenetrating titanium clips using a simple model that mimicked spinal surgery. In addition, the authors describe their surgical experience with these clips and the follow-up results in 31 consecutive patients.
The authors compared nonpenetrating titanium clips and expanded polytetrafluoroethylene (ePTFE) sutures in relation to the water pressure that could be tolerated by sutured ePTFE sheets, and the leakage pressure patterns were determined. The changes in leakage pressures at 5 minutes, 30 minutes, and 12 hours were examined when the clips and sutures were used in combination with the mesh-and-glue technique in an in vitro study. Thirty-one patients underwent spinal intradural procedures using nonpenetrating titanium clips to suture the dura maters using the meshand-glue technique, involving fibrin glue and polyglycolic acid-fibrin sheets.
A significant difference was apparent between the ePTFE suture group and the nonpenetrating titanium clip group, with the latter showing a leakage pressure that could be sustained and was 1508% higher than that of the former (p = 0.001). In relation to leakage patterns, the nonpenetrating titanium clips did not make any suture holes in the ePTFE sheet and fluid leakage occurred between the clips, whereas fluid leakage was associated with the pressure elevation that occurred at the suture holes made by the ePTFE sutures. Of the 31 patients who underwent spinal intradural procedures using nonpenetrating titanium clips, 1 (3.2%) experienced cerebrospinal fluid (CSF) leakage postoperatively. No other complications-for example, allergic reactions, adhesions, or infections--were encountered.
The interrupted placement of nonpenetrating titanium clips enables dural closure without creating any holes. These clips facilitate improvements in the initial leakage pressure and reduce postoperative CSF leakage following spinal surgery. The authors conclude that it is very beneficial to suture the spinal dura mater using nonpenetrating titanium clips given the anatomical characteristics of the spinal dura mater and the fact that the clips do not create suture holes.
非穿透性钛夹已成功应用于外周动脉搭桥手术。本研究的目的是使用一个模拟脊柱手术的简单模型来评估非穿透性钛夹的漏液压力和模式。此外，作者描述了他们使用这些夹子的手术经验以及31例连续患者的随访结果。
作者比较了非穿透性钛夹和膨体聚四氟乙烯（ePTFE）缝线在缝合ePTFE片所能耐受的水压方面的差异，并确定了漏液压力模式。在体外研究中，当夹子和缝线与网片和胶水技术联合使用时，检查了5分钟、30分钟和12小时时漏液压力的变化。31例患者接受了脊柱硬膜内手术，使用非穿透性钛夹通过网片和胶水技术缝合硬脑膜，其中包括纤维蛋白胶和聚乙醇酸-纤维蛋白片。
ePTFE缝线组和非穿透性钛夹组之间存在明显差异，后者的漏液压力能够维持，且比前者高1508%（p = 0.001）。关于漏液模式，非穿透性钛夹在ePTFE片上没有造成任何缝合孔，液体在夹子之间泄漏，而液体泄漏与ePTFE缝线造成的缝合孔处的压力升高有关。在31例使用非穿透性钛夹进行脊柱硬膜内手术的患者中，1例（3.2%）术后发生脑脊液（CSF）漏。未遇到其他并发症，如过敏反应、粘连或感染。
间断放置非穿透性钛夹可实现硬脑膜闭合而不产生任何孔。这些夹子有助于提高初始漏液压力，并减少脊柱手术后的术后CSF漏。作者得出结论，鉴于脊柱硬脑膜的解剖学特征以及夹子不会产生缝合孔这一事实，使用非穿透性钛夹缝合脊柱硬脑膜非常有益。
