粘连性蛛网膜炎伴硬膜外纤维化反复手术治疗的原因(临床一例)

A. Zhivotenko, V. Sorokovikov, Z. Koshkareva
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摘要

该工作提出了一个罕见的临床病例粘连蛛网膜炎,其发展对背景硬膜外纤维化反复手术干预。硬膜外腔瘢痕性粘连在术后100%形成,是反复手术干预(出血、脊髓及硬脑膜损伤及脑脊液流出)术中并发症的常见原因,因此手术治疗效果不理想,形成不同程度的持续疼痛、假性脑膜膨出、联合蛛网膜炎等。硬膜外腔瘢痕性粘连是导致背部手术失败综合征(FBSS)发生的主要原因,是目前脊柱外科的一个重要且尚未解决的问题。经手术的椎管脊髓运动段的硬膜外、硬膜下和蛛网膜下腔均可参与瘢痕粘连,我们的临床病例显示。在这方面,预防硬膜外腔瘢痕粘连的发展是重要的,因为随着人口预期寿命的增加和脊柱手术期间手术活动的增加,患者可以反复手术。由于硬膜外腔形成的瘢痕粘连没有有效的保守和手术治疗方法,反复手术干预会使手术治疗的良好和令人满意的预测变得更差,因此每次手术干预都不能100%地防止瘢痕粘连的形成。
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Formation of Adhesive Arachnoiditis with Epidural Fibrosis as a Cause of Repeated Surgical Interventions (Clinical Case)
The work presents a rare clinical case of adhesive arachnoiditis, which developed against the background of epidural fibrosis during repeated surgical interventions. The cicatricial adhesion in the epidural space is formed in 100% of cases after surgery and is a frequent cause of intraoperative complications during repeated surgical interventions (bleeding, damage to the spinal cord and the dura mater with subsequent outflow of cerebrospinal fluid) and, therefore, an unsatisfactory result of surgical treatment with the formation of constant pain of various intensity, pseudomeningocele, commissural arachnoiditis, etc. The cicatricial adhesion in the epidural space is the main reason for the development of failed back surgery syndrome (FBSS), which today is an important and unresolved problem in spinal surgery. The epidural, as well as the subdural and subarachnoid space of the operated spinal motor segment of the spinal canal can be involved in the cicatricial adhesion, as it is shown in our clinical example. In this regard, it is important to prevent the development of the cicatricial adhesion in the epidural space during primary spinal surgeries, since with the increase in life expectancy of the population and increase in surgical activity during spinal surgeries, the patient can be operated repeatedly. Consequently, the question arises of preventing the formation of the cicatricial adhesion in 100% of cases with each surgical intervention, since the formed cicatricial adhesion in the epidural space does not have effective methods of conservative and surgical treatment and worsens favorable and satisfactory forecasts of surgical treatment for repeated surgical interventions.
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