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[硬脑膜损伤类型及修复的研究现状]

[Research status of dural injury types and repair].

作者信息

Yang Yipeng, Zhang Yang, Lei Wei

机构信息

Department of Orthopedics, the First Affiliated Hospital of Air Force Medical University, Xi'an Shaanxi, 710032, P. R. China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Sep 15;37(9):1177-1182. doi: 10.7507/1002-1892.202306064.

Abstract

OBJECTIVE

To evaluate the current status of classification and repair methods for dural injury caused by spinal surgery or trauma, providing new strategies and ideas for the clinical repair of dural injury and the development of related materials.

METHODS

The literature related to dural injury both at home and abroad in recent years was thoroughly reviewed and analyzed in order to draw meaningful conclusions.

RESULTS

There have been numerous retrospective studies on dural injury, but there is a scarcity of prospective and multi-center studies, resulting in a low level of evidence-based research. The incidence and risk factors of dural injury have primarily been studied in relation to common degenerative spinal diseases of the cervical and lumbar spine, with insufficient research on thoracic spine-related diseases. Currently, a universally recognized method for grading and classifying dural injury has not been established, which hampers the development of clinical guidelines for their repair. Furthermore, although there are repair materials and surgical strategies available to address clinical issues such as suture leakage and surgical repair of dural injury in complex locations, there is a lack of comprehensive clinical research and evidence-based data to validate their scientificity and reliability.

CONCLUSION

Regardless of the classification of dural injury, suture remains the most important repair method. It is important to further develop new patches or sealants that can meet clinical needs and reduce the difficulty of repair.

摘要

目的

评估脊柱手术或创伤所致硬脊膜损伤的分类及修复方法现状,为硬脊膜损伤的临床修复及相关材料的研发提供新策略和思路。

方法

对近年来国内外有关硬脊膜损伤的文献进行全面回顾与分析,以得出有意义的结论。

结果

关于硬脊膜损伤已有众多回顾性研究,但前瞻性和多中心研究匮乏,导致循证研究水平较低。硬脊膜损伤的发生率及危险因素主要在颈椎和腰椎常见退行性脊柱疾病方面进行了研究,而胸椎相关疾病的研究不足。目前尚未建立普遍认可的硬脊膜损伤分级和分类方法,这阻碍了其修复临床指南的制定。此外,尽管有修复材料和手术策略可解决诸如缝合渗漏及复杂部位硬脊膜损伤的手术修复等临床问题,但缺乏全面的临床研究和循证数据来验证其科学性和可靠性。

结论

无论硬脊膜损伤如何分类,缝合仍是最重要的修复方法。进一步研发能满足临床需求并降低修复难度的新型补片或密封剂很重要。

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