中国组织工程研究Issue(34)：5513-5517,5.DOI:10.3969/j.issn.2095-4344.2015.34.020
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
Biomaterial repair combined with continuous lumbar subarachnoid drainage for management of cerebrospinal fluid leakage and meningitis after spinal surgery
摘要
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. Al cases underwent thorough debridement and intravenous injection of sensitive antibiotics folowed by continuous lumbar drainage and intrathecal administration of sensitive antibiotics (usualy 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 al 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.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Key words
Spine/Surgical Procedures, Operative/Intraoperative Complications/Subdural Effusion分类
医药卫生引用本文复制引用
周纲,张玉坤,黄卫民,王成伟..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[J].中国组织工程研究,2015,(34):5513-5517,5.基金项目
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@@@@the Scientific Innovation Fund of Xinjiang Medical University, No. XYDCX2014185 （XYDCX2014185）
