Duration of the horizontal decubitus position for prevention of cerebrospinal fluid leakage following transection of a tight filum terminale
Duration of the horizontal decubitus position for prevention of cerebrospinal fluid leakage following transection of a tight filum terminale
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DOI：
10.3171/2014.9.peds14289
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发表时间：
2015-05-01
影响因子：
1.9
通讯作者：
Morota, Nobuhito
中科院分区：
文献类型：
--
作者：
Ogiwara, Hideki;Joko, Masahiro;Morota, Nobuhito
目的 对于终丝过紧的患者，解开脊髓栓系是一个相对简单的手术，可以预防或改善神经系统症状。术后，患者通常保持水平卧位，以防止脑脊液漏。然而，尚未确定患者保持平躺的最佳时间。作者比较了 2 个不同时期水平卧位的队列；一组为 72 小时，另一组为 8 天。 方法 作者回顾性分析了 2 组用紧密终丝拴住脊髓的儿科患者的手术结果。一组在术后 8 天保持平稳，另一组在术后 72 小时保持平稳。审查了患者图表的人口统计数据、临床表现、手术治疗和临床病程。结果 354 名患者接受了紧绷终丝切断术。其中，238 例术后平躺 8 天，116 例平躺 72 小时：术后 1 至 2 周进行磁共振成像。两组患者均未出现脑脊液漏。 1 例平躺 8 天的患者出现假性脑膜膨出，经 MRI 证实。两组中脑脊液漏和假性脑膜膨出的发生率没有显着差异。 结论 让患者保持平躺超过 72 小时并不会改变术后脑脊液漏或假性脑膜膨出的发生率。在切断紧密的终丝后，七十二小时或更短的时间是保持患者平坦的适当时间。
OBJECT The untethering of a tethered spinal cord in patients with a tight filum terminale is a relatively simple procedure that can prevent or improve neurological symptoms. Postoperatively, patients are usually kept in the horizontal decubitus position to prevent a CSF leak. However, the optimal period for keeping patients flat has not been determined yet. The authors compared 2 cohorts with different periods of horizontal decubitus; one with 72 hours and the other with 8 days.METHODS The authors retrospectively analyzed surgical results in 2 cohorts of pediatric patients who had tethered spinal cord with a tight filum terminale. One cohort was maintained flat for 8 days and the other cohort for 72 hours post-operatively. The patients' charts were reviewed for demographic data, clinical presentation, surgical therapy, and clinical course.RESULTS Three hundred fifty-four patients underwent sectioning of a tight filum terminale. Of those, 238 were kept lying flat for 8 days postoperatively, and 116 were maintained flat for 72 hours: Magnetic resonance imaging was performed 1 to 2 weeks after the surgery. None of the patients in either cohort developed a CSF leak. Pseudomeningocele, which was confirmed by MRI, developed in 1 patient who had been kept flat for 8 days. The occurrence rates of a CSF leak and pseudomeningocele were not significantly different in either cohort.CONCLUSIONS Keeping patients flat for longer than 72 hours did not change the rate of postoperative CSF leakage or pseudomeningocele. Seventy-two hours or less would be an appropriate period for maintaining patients flat after transection of a tight filum terminale.