Fang Zhao, Jia Yu-Tao, Tian Rong, Liu Yang
Department of Spine Surgery, Tianjin Union Medicine Center, Tianjin Institute of Spine, Tianjin 300121, China.
Chin J Traumatol. 2016;19(1):35-8. doi: 10.1016/j.cjtee.2016.01.008.
Up to date, some approaches retarding the flow of cerebrospinal fluid (CSF) could be regarded as direct applications of the fluid mechanics (Poiseuille's law). However, there is a lack of the research on the efficacy of subfascial drainage for management of CSF leak after spine surgery based on the law. This is a prospective and comparative study on subfascial drainage for CSF.
Every four months in the three years from January 2010 to December 2012, the patients were enrolled respectively in Group A, Group B and Group C, in which, the drainage tube was discontinued within postoperative 3-4 days, 5-6 days, 7-10 days. Results and complications of postoperative CSF leak were investigated, and mean wound healing time (MWHT) of the three groups was compared.
A total of 108 cases (Group A/B/C:35/32/41) of CSF leak following posterior spine surgery were admitted to Tianjin Union Medicine Center, and 92 cases have been followed up for more than 1 year (follow-up rate of 85.2%). Preoperative demographics were similar among the 3 groups. In Group A, 7 patients developed CSF leak through the wound (CSFLW), of which 5 cases had to undergo reoperation. One case in Group A was confirmed to have pseudomeningocele at the 1st month after surgery. The MWHT was (16.6±3.6) days. In Group B, 3 patients developed CSFLWand cured by reoperation, in which 1 case of superficial infection recovered well after reoperation. MWHT was (11.4±2.2) days. In Group C, CSFLWwas not found and MWHT was (10.1±2.9) days. The differences of MWHT among Groups A, B and C were statistically significant.
Postoperative subfascial drainage, which is used to decrease the subfascial space pressure (P₂), would help wound healing. When it is placed for more than 7 days, the wound resistance (Rw) would be strong enough to withstand the subarachnoid pressure (P₁). Meanwhile, the power trans- duction in a sequence of Rw > P₂ > P₁ will indirectly retard CSF leak at the durotomy site and accordingly facilitate the healing of damaged spinal dura mater.
迄今为止，一些延缓脑脊液（CSF）流动的方法可被视为流体力学（泊肃叶定律）的直接应用。然而，基于该定律对脊柱手术后脑脊液漏进行筋膜下引流疗效的研究尚缺乏。这是一项关于脑脊液筋膜下引流的前瞻性对照研究。
在2010年1月至2012年12月的三年间，每四个月分别纳入A组、B组和C组患者，其中，引流管分别在术后3 - 4天、5 - 6天、7 - 10天拔除。调查术后脑脊液漏的结果及并发症，并比较三组的平均伤口愈合时间（MWHT）。
天津医科大学总医院共收治108例脊柱后路手术后脑脊液漏患者（A组/ B组/ C组：35/32/41），92例获得随访1年以上（随访率85.2%）。三组患者术前人口统计学特征相似。A组7例患者发生经伤口脑脊液漏（CSFLW），其中5例需再次手术。A组1例患者术后第1个月确诊为假性脑脊膜膨出。MWHT为（16.6±3.6）天。B组3例患者发生CSFLW，经再次手术治愈，其中1例浅表感染经再次手术后恢复良好。MWHT为（11.4±2.2）天。C组未发现CSFLW，MWHT为（10.1±2.9）天。A、B、C三组MWHT差异有统计学意义。
术后筋膜下引流用于降低筋膜下间隙压力（P₂），有助于伤口愈合。当放置超过7天时，伤口阻力（Rw）将足够强大以承受蛛网膜下腔压力（P₁）。同时，Rw > P₂ > P₁的顺序中的功率转换将间接延缓硬脑膜切开部位的脑脊液漏，从而促进受损硬脊膜的愈合。
