Strupp M, Brandt T, Müller A
Department of Neurology, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Germany.
J Neurol. 1998 Sep;245(9):589-92. doi: 10.1007/s004150050250.
The post-lumbar puncture syndrome (PLPS) can best be explained by prolonged spinal fluid leakage owing to delayed closure of a dural defect. Its incidence after spinal anaesthesia is much lower than after diagnostic lumbar puncture (LP). This difference could be caused by a strand of arachnoid, which might enter the needle with the outflowing cerebrospinal fluid (CSF) during diagnostic LP and upon removal of the needle be threaded back through the dura to produce prolonged CSF leakage. To find a technique that further reduces the incidence of PLPS, this hypothesis was tested by evaluating the effect that reinserting the stylet before removing the needle had on the incidence of PLPS. By reinserting the stylet to the tip of the needle, the hypothesized strand would be pushed out, thereby reducing the frequency of PLPS. Sprotte's "atraumatic needle" (21 gauge) was used for LP. A total of 600 patients participated in the prospective study. They were randomized into two groups and questioned about their complaints every day for up to 7 days after the LP. All LPs were performed by two experienced neurologists (T.B., M.S.). In 300 patients, the stylet was reinserted to the tip of the eedle; in the other 300 it was not reinserted. Whereas 49 of the 300 patients without reinsertion developed PLPS, only 15 of the 300 patients with reinsertion did. This significant difference (16.3 vs 5.0%, P < 0.005, chi square test) supports our hypothesis. On the basis of our results, we recommend reinserting the stylet before removing the needle in order to reduce the incidence of PLPS.
腰穿后综合征（PLPS）最好的解释是由于硬脊膜缺损延迟闭合导致脑脊液长期漏出。其在脊髓麻醉后的发生率远低于诊断性腰穿（LP）后。这种差异可能是由一缕蛛网膜引起的，在诊断性腰穿时，这缕蛛网膜可能随着流出的脑脊液进入针内，在拔出针时又穿过硬脊膜退回，导致脑脊液长期漏出。为了找到一种能进一步降低PLPS发生率的技术，通过评估在拔针前重新插入针芯对PLPS发生率的影响来验证这一假设。通过将针芯重新插入到针尖，推测中的那缕蛛网膜会被推出，从而降低PLPS的发生率。使用Sprotte的“无创伤针”（21号）进行腰穿。共有600名患者参与了这项前瞻性研究。他们被随机分为两组，并在腰穿后长达7天的时间里每天询问他们的不适情况。所有腰穿均由两名经验丰富的神经科医生（T.B.，M.S.）进行。300名患者重新将针芯插入到针尖；另外300名患者未重新插入。未重新插入针芯的300名患者中有49例发生了PLPS，而重新插入针芯的300名患者中只有15例发生。这种显著差异（16.3%对5.0%，P<0.005，卡方检验）支持了我们的假设。根据我们的结果，我们建议在拔针前重新插入针芯以降低PLPS的发生率。
