胸腰椎骨折合并硬脑膜撕裂的治疗策略

A. Martikyan, A. Grin, A. Talypov, A. Kordonskiy, I. Lvov, O. Levina, A. Prirodov
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The main group included 55 patients with dura mater tear, whereas the control group comprised 112 patients without dura mater tear.Results. Dura mater tear was found in 32.9 % of patients with fractures of the thoracic and lumbar spine. Of them, 21.8 % had compression of the spinal cord or nerve roots at the sites of dura mater tear. This fact should be taken into account when performing decompression and the reduction maneuver to prevent additional injuries to the neural structures. Thirty-three (60.0 %) patients underwent direct suturing aimed to restore the dura mater integrity. Their mean size of the dura mater tear was 13.2 ± 7.4 mm2. Thirteen patients (23.6 %) with larger dural tear (27.5 ± 6.3 mm2) underwent their repair using either a fragment of dura mater from a deceased donor (n = 2), Reperen implants (n = 5), or Durepair patches (n = 6). 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引用次数: 0

摘要

背景。硬脑膜撕裂在胸腰椎骨折患者中很常见。脑脊液漏的预防和处理及硬脑膜缝合线的封闭是治疗此类患者的重要阶段。目的:探讨胸腰椎骨折合并硬脑膜撕裂的最佳手术策略。材料和方法。本研究纳入167例手术治疗胸腰椎骨折并伴有外伤性椎管狭窄的患者。我们分析了他们的临床资料和仪器检查结果。所有患者均在骨折处行椎板切除术并经椎弓根固定。主组有硬脑膜撕裂55例,对照组无硬脑膜撕裂112例。32.9%的胸腰椎骨折患者出现硬脑膜撕裂。其中,21.8%的患者在硬脑膜撕裂部位压迫脊髓或神经根。在进行减压和复位操作以防止对神经结构造成额外损伤时,应考虑到这一事实。33例(60.0%)患者直接缝合以恢复硬脑膜完整性。硬脑膜撕裂的平均大小为13.2±7.4 mm2。13例(23.6%)硬脑膜撕裂较大的患者(27.5±6.3 mm2)采用已故供体硬脑膜碎片(n = 2)、recoen植入物(n = 5)或Durepair补片(n = 6)进行修复。在9例(16.4%)患者中,硬脑膜完整性无需缝合(“夹心”缝合法)即可恢复(硬脑膜缺损平均大小5.0±2.6 mm2)。21例患者采用生物胶缝合硬脑膜。主组55例患者中有5例出现术后伤口脑脊液漏。脑脊液漏在采用植入物修复硬脑膜的患者中最为常见(23.1%),而直接缝合硬脑膜的患者发生脑脊液漏的可能性较小(6.1%)。小缺损(≤3mm2)或硬脑膜撕裂位于神经根袖口的患者未见脑脊液漏。术后脑脊液漏患者无生物胶缝合线封堵硬脑膜。主要组4例(7.3%)发生术后伤口感染,对照组6例(5.4%)发生术后伤口感染。用胶液封堵硬脑膜缝合线是防止术后脑脊液漏的有效方法。用胶原蛋白海绵封堵硬脑膜缝合线不能防止伤口脑脊液漏出。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Treatment strategy for patients with thoracic and lumbar spine fractures with dura mater tear
Background. The dura mater tear are quite common in patients with thoracic and lumbar fractures. Prevention and management of cerebrospinal fluid leakage and sealing of the dura mater suture is an important stage in the treatment of such patients.Objective: to find an optimal surgical tactics for patients with fractures of the thoracic and lumbar spine and dura mater tear.Materials and methods. This study included 167 patients operated on for fractures of the thoracic and lumbar spine with concomitant traumatic spinal canal stenosis. We analyzed their clinical data and results of instrumental examination. All patients underwent laminectomy at the level of their fractures and transpedicular fixation. The main group included 55 patients with dura mater tear, whereas the control group comprised 112 patients without dura mater tear.Results. Dura mater tear was found in 32.9 % of patients with fractures of the thoracic and lumbar spine. Of them, 21.8 % had compression of the spinal cord or nerve roots at the sites of dura mater tear. This fact should be taken into account when performing decompression and the reduction maneuver to prevent additional injuries to the neural structures. Thirty-three (60.0 %) patients underwent direct suturing aimed to restore the dura mater integrity. Their mean size of the dura mater tear was 13.2 ± 7.4 mm2. Thirteen patients (23.6 %) with larger dural tear (27.5 ± 6.3 mm2) underwent their repair using either a fragment of dura mater from a deceased donor (n = 2), Reperen implants (n = 5), or Durepair patches (n = 6). In 9 patients (16.4 %), the integrity of dura mater was restored without suturing (the «sandwich»-sealing method) (mean size of the dura mater defect 5.0 ± 2.6 mm2). Twenty-one patients had additional sealing of dura mater suture using bioglue.Postoperative wound cerebrospinal fluid leakage was registered in 5 out of 55 patients from the main group. Cerebrospinal fluid leakage was most common in patients who had undergone dura mater repair with implants (23.1 %), while those who had undergone direct dura mater suturing were less likely to develop it (6.1 %). No cerebrospinal fluid leakage was observed in patients with small defects (≤3 mm2) or in those whose dural tears were located at the nerve root cuffs. Patients with postoperative cerebrospinal fluid leakage had no additional sealing of dura mater suture using bioglue.Postoperative wound infection was registered in 4 (7.3 %) patients from the main group and 6 (5.4 %) patients from the control group.Conclusion. Sealing of dura mater sutures with glue compositions is an effective method to prevent postoperative cerebrospinal fluid leakage. Sealing of dura mater sutures with a collagen sponge does not prevent wound cerebrospinal fluid leakage.
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