脊柱感染性疾病脑脊液漏的恒压闭式冲洗引流

Closed irrigation-drainage with constant pressure for cerebrospinal fluid leakage in infectious spinal diseases

摘要:

[目的] 观察恒压闭式冲洗引流术在脊柱感染性疾病脑脊液漏的应用疗效。[方法] 回顾性分析 2011 年 2 月—2021 年 1 月，采用术中修复，术后持续恒压闭式冲洗引流治疗脊柱感染性疾病脑脊液漏 11 例患者的临床资料。[结果] 11 例患者均顺利手术，术后切口愈合良好。所有患者均无头痛、脑膜刺激征等颅内感染表现。术中取病灶组织病理活检证实：化脓性感染 4 例，结核杆菌感染 3 例，未明确感染的炎性组织 4 例。随术后早期时间推移，患者 VAS 评分、体温、ESR 和 CRP 均显著下降(P＜0.05)。术后 MRI 检查显示硬膜破损处无脑脊液渗出征象，无脑脊液囊肿。随访 12 个月以上，所有患者均未再次出现高热、腰背疼痛加剧等症状。随时间推移，11 例患者 VAS 和 ODI 评分显著减少 (P＜0.05)，而 JOA 评分显著增加 (P＜0.05)。 [结论]术中修复与术后恒压闭式冲洗引流术治疗脊柱感染性疾病脑脊液漏安全可行。

Abstract:

[Objective] To observe the efficacy of closed irrigation-drainage with constant pressure for cerebrospinal fluid leakage in spinal infectious diseases. [Methods] A retrospective study was done on 11 patients who received intraoperative repair and postoperative closed irrigation-drainage with constant pressure for cerebrospinal fluid leakage secondary to surgical treatment for spinal infectious diseas- es in our hospital from February 2011 to January 2021. [Results] All the 11 patients were successfully operated on with wound healing well. There were no manifestations of intracranial infection, such as headache and meningeal irritation in anyone of them. Pathological biopsy in operation revealed that 4 cases were of suppurative infection, 3 cases were tuberculosis bacillus infection, and remaining 4 cases were in- flammatory tissue without definite infection. The VAS score, temperature, ESR and CRP decreased significantly over time in the early stage after operation (P＜0.05) . The postoperative MRI showed no cerebrospinal fluid exudation and no cerebrospinal fluid cyst in any case. Dur- ing the follow up period lasted for more than 12 months, no symptoms, such as high fever and severe back pain, occurred again in any case. The VAS and ODI scores decreased significantly, whereas JOA score increased significantly over time in 11 patients (P＜0.05) . [Conclusion] Intraoperative repair and postoperative closed irrigation-drainage with constant pressure are safe and feasible treatment for cerebro- spinal fluid leakage in spinal infectious diseases.