| Background: Cerebrospinal fluid leakage(CSFL)is one of the common complications after spinal surgery.With the increasing number of spinal surgery,the incidence of cerebrospinal fluid leakage after spinal surgery is also increasing.Serious life-threatening complications such as subcutaneous hydrops,incision infection,pseudocyst,even subdural hematoma,and central system infection may occur if the operation is not handled properly.At present,there are many treatment methods for CSFL after spinal surgery,including posture adjustment,wound pressure dressing,lumbar cisterna drainage and subfascial drainage,etc.Although the above methods have achieved good results in clinical treatment,there are still many controversies.In recent years,more and more studies have shown that subfascial drainage is more effective in the treatment of CSFL after spinal surgery than other treatment methods.However,there is no consensus on the disposal and drainage time of the subfascial drainage tube after operation.Therefore,based on the relevant research and clinical experience at home and abroad,the author makes a summary of this problem,and proposes continuous subfascial drainage on the basis of subfascial drainage.In order to investigate the clinical efficacy of continuous subfascial drainage in the treatment of CSFL after spinal surgery,the following analysis is performed.Objective:To investigate the clinical efficacy of continuous subfascial drainage in the treatment of CSFL after spinal surgery.Methods: A retrospective analysis was conducted on the clinical data of 85 patients(3.61%)with CSFL after 2356 posterior spinal open surgeries performed by the same doctor in the Department of Spine Surgery,the First Affiliated Hospital of Dali University from January 2014 to December 2021.According to the different treatment methods of postoperative CSFL,they were divided into group A and group B.Group A included 21 patients who were treated with early extubation and pressure bandage from January 2014 to July 2016.Group B included 64 patients who were treated with continuous subfascial drainage from August 2016 to December 2021.Among them,4patients with unplanned drainage tube removal after operation were considered as special cases and discussed separately,and were not included in the statistical analysis.The average daily drainage volume,the average extubation time,the average postoperative antibiotic use time,the average postoperative bed time,the average postoperative hospital stay,the inflammatory indicators(WBC and CRP)on the 3rd and5 th days after surgery,the rate of incision grade A healing,and the postoperative bed rest related complications(deep venous thrombosis of lower limbs,hypostatic pneumonia,intestinal obstruction,etc.)were compared between the two groups.Csfl-related complications(general complications: dizziness,headache,vomiting caused by intracranial hypotension;Severe complications: subcutaneous effusion,incision infection,spinal pseudocyst,central infection,etc.).To evaluate the clinical efficacy of two methods in the treatment of CSFL after spinal surgery.Results: In terms of postoperative observation indicators: In group A,the average daily drainage volume was 234.25±67.96ml/d,the average extubation time was 3d,the average postoperative antibiotic use time was 8.24±1.03 d,the average postoperative bed time was 4d,the average postoperative hospital stay was 8.42±1.56 d,and the WBC on the third postoperative day was 14.23±1.89 10^9/L.The CRP was 34.26±20.66mg/L on the 3rd day after operation,the WBC was 13.03±2.78 10^9/L on the 5th day after operation,and the CRP was 28.90±18.37mg/L on the 5th day after operation.In group B,the average daily drainage volume was 350.27±48.16ml/d,the average extubation time was 9.44±3.53 d,the average postoperative antibiotic use time was 8.45±0.96 d,the average postoperative bed time was 10.44±3.53 d,and the average postoperative hospital stay was 14.82±3.13 d.The WBC and CRP were 12.02±1.44 10^9/L and23.16±20.19mg/L on the 3rd day and 10.11±2.23 10^9/L and 20.20±18.67mg/L on the5 th day after operation,respectively.Compared with group A,the average daily drainage volume,the average extubation time,the average postoperative bed time and the average postoperative hospital stay in group B were significantly increased(P <0.05).The inflammatory indexes(WBC and CRP)in group B were lower than those in group A at 3 and 5 days after operation,and the differences were statistically significant(P < 0.05).There was no significant difference in the average duration of postoperative antibiotic use between the two groups(P > 0.05).In terms of clinical efficacy: 13 patients in group A had grade A wound healing,7 patients had grade B wound healing,and 1 patient had grade C wound healing,and the rate of grade A wound healing was61.9%.Among the general complications of CSFL,8 patients had dizziness and headache(1 patient was accompanied by vomiting),with an incidence of 38.10%.Among the serious complications of CSFL,1 case had pseudodural cyst combined with central infection,1 case had subcutaneous effusion,and 1 case had incision infection,with an incidence of 14.28%.All patients had no bedridden related complications,and the incidence was 0%.CSFL was obviously controlled in all patients,and the cure rate was 100%.All the 60 patients in group B had grade A wound healing,and the grade A wound healing rate was 100%.Among the general complications of CSFL,38 patients had dizziness and headache,including 8 patients with vomiting,and the incidence rate was 63.33%.No bed rest related complications and severe complications of CSFL occurred in all patients,and the incidence was 0%.CSFL was obviously controlled in all patients,and the cure rate was 100%.The rate of grade A wound healing and the incidence of general complications of CSFL in group B were significantly higher than those in group A,the differences were statistically significant(P < 0.05).The incidence of serious complications of CSFL in group B was significantly lower than that in group A(P < 0.05).There was no significant difference in the incidence of bed-related complications and the cure rate of CSFL between the two groups(P > 0.05).In addition,among the 4 special case patients,2 patients had dizziness and headache(1 patient had vomiting),1 patient had incision infection,and 1 patient had central infection.Conclusion: Continuous subfascial drainage is a simple,safe and effective method for the treatment of CSFL after spinal surgery.Especially for patients with implants after spinal surgery,it can significantly reduce the occurrence of serious complications of CSFL and is worthy of promotion and application. |
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