Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
Kirishima Orthopedic Surgery, Kirishima, Japan.
Sci Rep. 2024 Oct 9;14(1):23613. doi: 10.1038/s41598-024-75085-x.
After surgery for intradural lesions, dural reconstruction is essential for preventing cerebrospinal fluid (CSF) leakage, which can cause serious complications. However, there is currently no established intraoperative procedure. While hydrophobic polyglycolic acid (PGA) sheets and fibrin glue are effective for dural reconstruction, the usefulness of hydrophilic artificial dura mater made of a porous collagen matrix has also been reported. This study aimed to compare the ability of a fibrin-coated porous collagen matrix and a fibrin-coated PGA sheet to prevent CSF leakage during spinal surgery. This study included 319 patients who underwent surgery for intradural lesions requiring dural reconstruction. Patients in the PGA sheet group (group P) and the porous collagen matrix group (group C) were compared. The median age was 60 years. A total of 319 patients were included, with 219 in Group P and 100 in Group C. CSF leakage occurred in 11 patients (5.0%) in Group P and 0 patients in Group C (P < 0.05). This is the first report showing the superiority of a porous collagen matrix sheet over a PGA sheet in preventing CSF leakage during spinal surgery. The porous collagen matrix is hydrophilic and may be more effective against CSF leakage than hydrophobic PGA sheets.
术后硬脊膜内病变，硬脑膜重建对于预防脑脊液（CSF）渗漏至关重要，因为它可能导致严重的并发症。然而，目前还没有确立的术中程序。虽然疏水性聚乙二醇酸（PGA）片和纤维蛋白胶可有效进行硬脑膜重建，但多孔胶原基质制成的亲水性人工硬脑膜的有效性也已得到报道。本研究旨在比较纤维蛋白涂层多孔胶原基质和纤维蛋白涂层 PGA 片在预防脊柱手术中 CSF 渗漏的能力。本研究纳入了 319 例因硬脊膜内病变需要硬脑膜重建而行手术的患者。将 PGA 片组（P 组）和多孔胶原基质组（C 组）进行比较。中位年龄为 60 岁。共纳入 319 例患者，其中 P 组 219 例，C 组 100 例。P 组中有 11 例（5.0%）患者发生 CSF 渗漏，C 组中无患者发生 CSF 渗漏（P<0.05）。这是首个报告表明，在预防脊柱手术中的 CSF 渗漏方面，多孔胶原基质片优于 PGA 片。多孔胶原基质是亲水性的，可能比疏水性 PGA 片更能有效防止 CSF 渗漏。
