假性脑膜膨出是一种罕见但广泛认可的脊柱手术并发症,可能难以纠正。当保守措施失败时,患者经常需要再次手术以尝试初次闭合硬体切开术,然而,试图真正水密封闭的硬脑膜或筋膜有时会失败。我们描述了一种腰骶部假性脑膜膨出修复技术,该技术涉及对假性脑膜膨出进行2层裤子-背心闭合,并动员双侧椎旁肌肉组织以形成Z成形术。或Z形皮瓣。我们的小系列已经证明了很高的成功率。
该技术对假性脑膜膨出进行了细致的操作,以制作2层背心上的裤子。这种闭合,再加上广泛的动员和向伤口中输入的脊柱旁肌肉,可以有效地消除死腔,同时填充硬脑膜撕裂。侧排穿孔器完好无损,提供良好的血管和足够的流动性给病人。
这项技术在2004年至2019年7月期间被纳入了10名患者的护理中。根据伤口的需要,在仔细的皮瓣切片后,所有伤口都在一个阶段闭合。我们证明,在至少6个月的随访后,所有10例患者的假性脑膜膨出均未观察到临床复发。
这项技术为脊柱外科医生提供了一个简单的选择,以最小的速度管理这些具有挑战性的脊柱伤口,如果有的话,需要进一步的椎板切除术以及高的瘘管控制率和最低的发病率。
Pseudomeningocele is an uncommon but widely recognized complication of spinal surgery that can be challenging to correct. When conservative measures fail, patients frequently require reoperation to attempt primary closure of the durotomy, yet attempts at true watertight closures of the dura or fascia sometimes fall short. We describe a technique of lumbosacral pseudomeningocele repair involving a 2-layer pants-over-vest closure of the pseudomeningocele coupled with mobilization of bilateral paraspinal musculature to create a Z-plasty, or a Z-shaped flap. We have demonstrated a high success rate with our small series.
The technique used meticulous manipulation of the pseudomeningocele to make a 2-layer pants-over-vest closure. This closure coupled with wide mobilization and importation of paraspinous muscle into the wound effectively obliterated dead space with simultaneous tamponade of the dural tear. The lateral row perforators were left intact, providing excellent vascularity with adequate mobility to the patient.
This technique was incorporated into the care of 10 patients between 2004 and July 2019. All wounds were closed in a single stage after careful flap section based on the wound\'s needs. We demonstrated successful pseudomeningocele resolution in all 10 patients with no observed clinical recurrence of symptomatic pseudomeningocele after at least 6 months of follow-up.
This technique provides a straightforward option for the spine surgeon to manage these challenging spinal wounds with minimal, if any, need for further laminectomy as well as a high fistula control rate with minimal morbidity.