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因臀部着地摔倒后棘突咬断导致腰大池-腹腔分流术后早期腰椎导管切断：病例报告

Early postoperative lumbar catheter severing in a lumboperitoneal shunt due to bite-off by the spinous processes following a fall on the buttocks: illustrative case.

作者信息

Munakata Ryoji, Horiuchi Kazuomi, Watanabe Zenichiro, Segawa Banri, Kobayashi Yuta, Kameno Rikiya, Onuki Akinori, Fujimori Daichi, Oinuma Masahiro, Watanabe Kazuo

机构信息

Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Koriyama, Fukushima, Japan.

出版信息

J Neurosurg Case Lessons. 2024 Dec 30;8(27). doi: 10.3171/CASE24509.

DOI:10.3171/CASE24509
PMID:39740214
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11694187/
Abstract

BACKGROUND

Rupture of the lumbar catheter in lumboperitoneal (LP) shunts is rare and typically occurs due to long-term mechanical stress. The authors describe an unusual case of early postoperative lumbar catheter severing after a fall on the buttocks.

OBSERVATIONS

A 78-year-old woman underwent LP shunt placement for communicating hydrocephalus after aneurysmal subarachnoid hemorrhage. The lumbar catheter was inserted via a median approach, and the postoperative course was uneventful. However, 2 months after the LP shunt surgery, she accidentally fell on her buttocks in the hospital ward. Radiography showed a rupture of the lumbar catheter due to the shearing force caused by compression of the spinous processes from the impact of the fall.

LESSONS

In patients who have undergone catheter placement via a median approach, even within a short period after LP shunt placement, the lumbar catheter that has deteriorated due to "pinch-off" can rupture due to "bite-off" by the spinous processes following a fall on the buttocks. https://thejns.org/doi/10.3171/CASE24509.

摘要

背景

腰大池-腹腔（LP）分流术中腰大池导管破裂罕见，通常因长期机械应力所致。作者描述了1例术后早期因臀部着地摔倒导致腰大池导管切断的罕见病例。

观察结果

一名78岁女性在动脉瘤性蛛网膜下腔出血后因交通性脑积水接受了LP分流术。腰大池导管经正中入路插入，术后过程顺利。然而，LP分流术后2个月，她在医院病房不慎臀部着地摔倒。影像学检查显示，由于摔倒撞击导致棘突压迫产生的剪切力，致使腰大池导管破裂。

经验教训

对于经正中入路放置导管的患者，即使在LP分流术后短期内，因“夹闭”而受损的腰大池导管在臀部着地摔倒后也可能因棘突“咬断”而破裂。https://thejns.org/doi/10.3171/CASE24509

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/90fa/11694187/186c06d25e48/CASE24509_figure_3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/90fa/11694187/e4f920d19029/CASE24509_figure_1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/90fa/11694187/0828cfd119fc/CASE24509_figure_2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/90fa/11694187/186c06d25e48/CASE24509_figure_3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/90fa/11694187/e4f920d19029/CASE24509_figure_1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/90fa/11694187/0828cfd119fc/CASE24509_figure_2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/90fa/11694187/186c06d25e48/CASE24509_figure_3.jpg

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本文引用的文献

1
Late intrathecal retraction of a lumboperitoneal shunt.腰大池-腹腔分流管的晚期鞘内回缩
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2
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Oper Neurosurg (Hagerstown). 2019 Apr 1;16(4):471-477. doi: 10.1093/ons/opy176.
3
Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial.
特发性正常压力脑积水的腰椎腹腔分流术（SINPHONI-2）：一项开放标签随机试验。
Lancet Neurol. 2015 Jun;14(6):585-94. doi: 10.1016/S1474-4422(15)00046-0. Epub 2015 Apr 28.
4
The interlaminar and the narrowest distances at the L3/4 and L4/5 interspinous spaces and location of the intercrestal line in Thai cadavers.泰国尸体中L3/4和L4/5棘突间间隙的层间及最窄距离以及髂嵴间线的位置。
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Migrating lumbar intrathecal catheter fragment associated with intracranial subarachnoid hemorrhage.移行性腰椎蛛网膜下腔内置管碎片并颅内蛛网膜下腔出血。
J Neurosurg Spine. 2015 Jan;22(1):47-51. doi: 10.3171/2014.9.SPINE147.
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Subarachnoid hemorrhage due to retained lumbar drain.因留置腰椎引流管导致的蛛网膜下腔出血。
J Neurosurg Spine. 2011 Dec;15(6):641-4. doi: 10.3171/2011.8.SPINE11387. Epub 2011 Sep 9.
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Spinal intradural granuloma as a complication of an infected cerebrospinal fluid drainage tube fragment--case report.脊髓硬膜内肉芽肿作为感染性脑脊液引流管碎片的并发症——病例报告
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