Spinal dural closure with nonpenetrating titanium clips in pediatric neurosurgery Clinical article
Spinal dural closure with nonpenetrating titanium clips in pediatric neurosurgery Clinical article
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DOI：
10.3171/2010.7.peds09545
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发表时间：
2010-10-01
影响因子：
1.9
通讯作者：
Lew, Sean M.
中科院分区：
文献类型：
--
作者：
Kaufman, Bruce A.;Matthews, Anne E.;Lew, Sean M.
Object.作者报告了他们在27例（26例患者）脊柱手术中使用非穿透性钛吻合夹进行硬脑膜闭合的经验的回顾性综述。本综述的目的是确定这些夹子在小儿神经外科脊柱手术中的实用性，确定其使用的并发症，并评估其使用对术后影像学的影响。获得了机构审查委员会的批准，对使用钛质硬脑膜夹的所有患者进行回顾性病历审查。使用医院和诊所记录在2年内确定患者，并收集患者人口统计学、手术诊断和程序、脉络膜切开术位置和长度以及连续闭合方法的数据。评估术后并发症。对术后影像学资料进行回顾性分析。26名患者在20个月内接受了27次手术。他们的年龄从2.5个月到18.5岁不等，中位年龄为3.2岁，平均年龄为5.8岁。19例患者的手术诊断为某种形式的脊柱闭合不全，各2例患者有空洞或硬膜撕裂，3例患者有蛛网膜囊肿; 1例患者切除了肿瘤。手术节段包括腰骶（19）、胸椎（7）和颈椎（1）。16例病例的硬膜暴露仅限于1个椎板节段，8例仅限于2个节段，1例仅限于3个节段; 2例涉及局灶性硬膜撕裂。在16例病例中，将额外的止血和组织封闭剂材料组合应用于结扎夹上。1例患者在钛夹置入后13个月需要再次手术。之前使用钛夹不会使后续暴露和打开变得更加复杂。在1至24个月的随访期内，未发现明显的并发症。没有记录到CSF泄漏。钛夹在X线平片上不易观察到，在CT或MR成像上也不会引起伪影或失真。非穿透性钛吻合夹提供了一种有效的闭合方法，同时限制了所需的暴露，从而允许更微创的方法。在狭窄的空间中，与传统的硬膜外固定相比，使用夹更容易和更快地完成硬膜闭合。使用金属夹未观察到显著并发症，金属夹未干扰术后成像。(DOI：10.3171/2010.7.PEDS09545）
Object. The authors report a retrospective review of their experience using nonpenetrating titanium anastomotic clips for dural closure in 27 pediatric cases (26 patients) of spinal surgery for a variety of diagnoses. The goal of this review was to define the utility of these clips in pediatric neurosurgical spinal procedures, identify complications of their use, and assess the effects on postoperative imaging because of their use.Methods. Institutional review board approval was obtained for a retrospective chart review of all patients in whom titanium dural clips had been utilized. Patients were identified over a 2-year period using hospital and clinic records, and data were collected on the patient demographics, surgical diagnosis and procedure, clurotomy location and length, and adjunctive closure methods. Postoperative complications were assessed. When available, postoperative imaging data were reviewed.Results. Twenty-six patients underwent 27 operations over a 20-month period. They ranged in age from 2.5 months to 18.5 years, with a median age of 3.2 years and an average age of 5.8 years. The operative diagnosis was some form of spinal dysraphism in 19 patients, with a syrinx or dural tear in 2 patients each, and an arachnoid cyst in 3 cases; I patient had a tumor resected. Operative levels included lumbosacral (19), thoracic (7), and cervical (1). Dural exposure was limited to 1 laminar level in 16 cases, 2 levels in 8, and 3 levels in 1; 2 cases involved focal dural tears. A combination of additional hemostatic and tissue sealant materials was applied over the clips in 16 cases. One patient required reoperation 13 months after clip placement. Prior clip use did not make subsequent exposure and opening more complicated. No significant complications were identified in the follow-up period ranging from 1 to 24 months. There were no documented CSF leaks. The clips are not easily seen on plain radiographs and did not cause artifacts or distortion on either CT or MR imaging.Conclusions. Nonpenetrating titanium anastomotic clips afford an effective means of closure while limiting the exposure needed, and thus allowing more minimally invasive approaches. In tight spaces, dural closure is accomplished more easily and faster with the clips as compared with conventional suturing. No significant complications were seen from clip use, and the clips did not interfere with postoperative imaging. (DOI: 10.3171/2010.7.PEDS09545)