Wang J C, Bohlman H H, Riew K D
University Hospitals Spine Institute, Department of Orthopaedic Surgery, University Hospitals of Cleveland and Case Western Reserve University School of Medicine, Ohio 44106, USA.
J Bone Joint Surg Am. 1998 Dec;80(12):1728-32. doi: 10.2106/00004623-199812000-00002.
We reviewed the results of acute management of patients who had sustained a dural tear during an operation on the lumbar spine, and we attempted to determine the long-term sequelae of this complication. In the five years from July 1989 to July 1994, 641 consecutive patients had a decompression of the lumbar spine, performed by the senior one of us; of these patients, eighty-eight (14 percent) sustained a dural tear, which was repaired during the operation. The duration of follow-up ranged from two to eight years (average, 4.3 years). Postoperative management consisted of closed suction wound drainage for an average of 2.1 days and bed rest for an average of 2.9 days. Of the eighty-eight procedures that resulted in a dural tear, forty-five were revisions; these revisions were performed after an average of 2.2 previous operations on the lumbar spine, all of which resulted in a scar adherent to the dura. Only eight patients had headaches related to the spinal procedure and photophobia in the postoperative period; these symptoms resolved in all but two patients, both of whom had had a revision operation. Each of the two patients had symptoms of a persistent leak of spinal fluid and needed a reoperation for repair. Overall, seventy-six patients had a good or excellent result and twelve had a poor or satisfactory result with some residual back pain. One patient had arachnoiditis, and another had symptoms of viral meningitis one month postoperatively. A dural tear that occurs during an operation on the lumbar spine can be treated successfully with primary repair followed by bed rest. Such a tear does not appear to have any long-term deleterious effects or to increase the risk of postoperative infection, neural damage, or arachnoiditis. Closed suction wound drainage does not seem to aggravate the leak and can be used safely in the presence of a dural repair.
我们回顾了腰椎手术中发生硬脊膜撕裂患者的急性处理结果，并试图确定这一并发症的长期后遗症。在1989年7月至1994年7月的五年间，我们中的年长者连续为641例患者进行了腰椎减压手术；其中88例（14%）发生了硬脊膜撕裂，并在手术中进行了修复。随访时间为2至8年（平均4.3年）。术后处理包括平均2.1天的闭式负压伤口引流和平均2.9天的卧床休息。在导致硬脊膜撕裂的88例手术中，45例为翻修手术；这些翻修手术平均在先前2.2次腰椎手术后进行，所有这些手术均导致瘢痕粘连至硬脊膜。术后仅有8例患者出现与脊柱手术相关的头痛和畏光症状；除2例患者外，所有这些症状均已缓解，这2例患者均接受了翻修手术。这2例患者均有持续脑脊液漏的症状，需要再次手术修复。总体而言，76例患者结果良好或优秀，12例结果较差或尚可，有一些残留背痛。1例患者发生蛛网膜炎，另1例患者术后1个月出现病毒性脑膜炎症状。腰椎手术中发生的硬脊膜撕裂通过一期修复并随后卧床休息可成功治疗。这种撕裂似乎不会产生任何长期有害影响，也不会增加术后感染、神经损伤或蛛网膜炎的风险。闭式负压伤口引流似乎不会加重渗漏，在存在硬脊膜修复的情况下可安全使用。
