中国组织工程研究

中国组织工程研究 ›› 2015, Vol. 19 ›› Issue (34): 5513-5517.doi: 10.3969/j.issn.2095-4344.2015.34.020

• 膜生物材料 membrane biomaterials • 上一篇    下一篇

硬脊膜修补并腰大池置管持续引流：脊柱手术后脑脊液漏合并脑膜炎的治疗

周  纲，张玉坤，黄卫民，王成伟   

  1. 新疆医科大学第六附属医院脊柱外科，新疆维吾尔自治区乌鲁木齐市  830002
  • 出版日期:2015-08-20 发布日期:2015-08-20
  • 通讯作者: 黄卫民，新疆医科大学第六附属医院脊柱外科，新疆维吾尔自治区乌鲁木齐市 830002
  • 作者简介:周纲，男，1981年生，主治医师，主要从事脊柱外科研究。
  • 基金资助:

    新疆医科大学科研创新基金项目(XYDCX2014185)：后路腰椎单侧椎弓根钉固定临床应用的相关研究

Biomaterial repair combined with continuous lumbar subarachnoid drainage for management of cerebrospinal fluid leakage and meningitis after spinal surgery 

Zhou Gang, Zhang Yu-kun, Huang Wei-min, Wang Cheng-wei   

  1. Department of Spine Surgery, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China
  • Online:2015-08-20 Published:2015-08-20
  • Contact: Huang Wei-min, Department of Spine Surgery, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China
  • About author:Zhou Gang, Attending physician, Department of Spine Surgery, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China
  • Supported by:

    the Scientific Innovation Fund of Xinjiang Medical University, No. XYDCX2014185

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摘要：

背景：创伤性或医源性的硬脊膜缺损可引发持续性脑脊液漏，甚至进展为危及生命的化脓性脑膜炎。当脑脊液漏合并脑膜炎时，由于脑脊液为细菌良好的培养基，同时因血脑屏障的存在，大多数抗生素不易到达脑脊液内，所以脑膜炎一旦发生表现为发病急、进展快、感染不易控制。
目的：评价生物材料修补破损硬脊膜后，腰大池置管引流加鞘内给药治疗脊柱术后脑脊液漏合并脑膜炎的疗效。
方法：新疆医科大学第六附属医院脊柱外科2008年6月至2013年6月共进行脊柱手术2 266例，术后发生脑脊液漏126例，发生率为5.56%，其中合并脑膜炎者12例。患者术中发现硬脊膜破损者，直接缝合或取自体筋膜片修补。所有病例进行彻底的清创，静脉使用敏感抗生素，然后行腰大池置管持续引流，同时将敏感抗生素(一般用万古霉素)自腰大池引流管鞘内注入给药，一期关闭切口。回顾分析12例患者的病历资料及治疗结果。
结果与结论：12例患者脑脊液漏出现时间为术后24-72 h，平均48 h；感染出现时间为术后8-12 d，平均9.5 d。鞘内注射万古霉素后第2天头痛、发热等症状明显缓解，腰大池置管引流7-14 d后颅内感染症状完全消失，脑脊液生化及常规检查连续3次均正常，普通细菌培养无菌生长，将腰大池引流管拔除。所有患者无因腰大池置管引流引起的椎管内感染、低颅压性头痛、脑疝等并发症。提示，自体筋膜修补硬脊膜联合腰大池置管引流加鞘内给药对脊柱术后脑脊液漏合并脑膜炎的治疗是有效的。

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 生物材料, 材料相容性, 脑脊液漏, 腰大池置管持续引流, 脊柱手术, 疗效

Abstract:

BACKGROUND: Traumatic or iatrogenic dural defects can cause persistent cerebrospinal fluid leakage, even progressing to life-threatening purulent meningitis. In patients with meningitis combined with cerebrospinal fluid leakage, most antibiotics are unable to enter the cerebrospinal fluid, as the cerebrospinal fluid is a good medium for bacteria and there is the presence of blood-brain barrier. So meningitis presents with acute onset, rapid development and infection difficult to control.
OBJECTIVE: To evaluate the outcome of continuous lumbar subarachnoid drainage plus intrathecal administration of antibiotics for postoperative cerebrospinal fluid leakage combined with meningitis after biomaterial repair of dural defects.
METHODS: A retrospective study was carried out to review the 12 cases of cerebrospinal fluid leakage combined with meningitis among 126 of 2 266 cases who developed cerebrospinal fluid leakage (5.56%) undergoing spinal 
surgery from June 2008 to June 2013. During the operation, dural defects were directly sutured or repaired with autologous fascial sheet. All cases underwent thorough debridement and intravenous injection of sensitive antibiotics followed by continuous lumbar drainage and intrathecal administration of sensitive antibiotics (usually vancomycin), and then the incision was closed at stage I.
RESULTS AND CONCLUSION: The cerebrospinal fluid leakage was found in the 12 cases at 24-72 hours after surgery, averagely 48 hours; the infection was found at 812 days days after surgery, averagely 9.5 days. Headache and fever were significantly relieved at the 2nd day of intrathecal administration of antibiotics, and intracranial infection disappeared at 7-14 days after continuous lumbar drainage. Biochemical test of the cerebrospinal fluid and routine examination were done thrice, and the results were all normal. No bacterial growth was found in bacterial culture test, and the drainage tube was removed. There was no intraspinal infection, intracranial hypotension headache and hernia caused by the drainage tube. These findings indicate that autologous fascia repair combined with continuous lumbar subarachnoid drainage plus intrathecal administration of antibiotics is an effective method in the treatment of cerebrospinal fluid leakage with meningitis.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Spine, Surgical Procedures, Operative, Intraoperative Complications, Subdural Effusion

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