Analysis of the effect of free paraspinal muscle flap tamponade in the treatment of intraoperative nerve root axillary dural rupture with cerebrospinal fluid leakage
游离椎旁肌瓣填塞治疗术中神经根腋下硬脊膜破裂伴脑脊液漏的效果分析

摘要

目的 比较游离椎旁肌瓣填塞、人工硬脊膜修复和硬脊膜缝合治疗术中神经根腋下硬脊膜破裂的临床疗效。方法 选取2018年1月—2021年7月北京德尔康尼骨科医院600余例腰椎后路开放手术中，神经根腋下硬脊膜破裂的34例脊柱疾病患者，根据硬脊膜修复方法将患者分为A组：单纯缝合组（10例）、B组：单纯人工硬脊膜修复组（12例）和C组：游离椎旁肌瓣填塞组（12例），术后给予抗生素等常规处理，记录术后引流量、引流时间，及术后脑脊液漏发生情况、切口有无积液及感染，术后影像学复查有无假性硬脊膜囊肿，比较三组患者术前术后腰痛、腿痛VAS评分，采用SF－36生活质量量表对手术前后生活质量进行评定。结果 比较三组患者性别、年龄等一般资料，差异均无统计学差异（P>0.05），具有可比性。术后1、2、3 d游离椎旁肌瓣填塞治疗的引流量少于单纯人工硬脊膜组，且均少于单纯缝合组，差异均有统计学差异（P<0.05）。游离椎旁肌瓣填塞术后1 d引流量多于术后2、3 d，差异均有统计学差异（P<0.05）。C组术后腰痛VAS评分，腿痛VAS评分，脑脊液漏发生率，感染发生率及假性硬膜囊肿发生率均低于A组及B组，差异均有统计学差异（P<0.05）。结论 采用游离椎旁肌瓣填塞对治疗术中神经根腋下硬脊膜破裂患者有较好的效果，临床值得推广。

Abstract

Objective: To compare the clinical efficacy of free paraspinal muscle flap packing, artificial dura mater repair and dural suture in the treatment of intraoperative nerve root axillary dura mater rupture.
Methods: Thirty-four patients with spinal diseases who had nerve root axillary dura rupture in more than 600 cases of spinal surgery in Delconi orthopedic hospital from January 2018 to July 2021 were selected. The patients were divided into group A: simple suture group (10 cases), group B: simple artificial dural repair group (12 cases), and group C: free paraspinal muscle flap packing group (12 cases), and they were given routine antibiotics after operation. Treatment, recording the postoperative drainage volume, drainage time, the occurrence of postoperative cerebrospinal fluid leakage, whether there is effusion and infection in the incision, and whether there is a pseudodural cyst after the postoperative imaging review, and compare the three groups of patients with low back pain before and after surgery , VAS score of leg pain, and SF-36 quality of life scale was used to evaluate the quality of life before and after surgery.
Results: There was no statistical difference in gender, age and other general information of the three groups of patients (P>0.05), which was comparable. The drainage volume of free paravertebral muscle flap tamponade treatment at 1, 2, and 3 days after operation was less than that of the simple artificial dura mater group, and was less than that of the simple suture group, and the differences were statistically significant (P<0.05). The drainage volume of the free paravertebral muscle flap on the 1st day after tamponade was more than that on the 2nd and 3rd day after the operation, and the difference was statistically significant (P<0.05). The postoperative back pain VAS score, leg pain VAS score, the incidence of cerebrospinal fluid leakage, the incidence of infection and the incidence of pseudodural cyst in group C were lower than those in group A and group B, and the differences were statistically significant (P<0.05).
Conclusion  : The use of free paraspinal muscle flap packing has a good effect in the treatment of patients with nerve root axillary dural rupture during operation, and it is worthy of clinical promotion.