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Cerebrospinal fluid leakage and headache after lumbar puncture: a prospective non-invasive imaging study.
腰椎穿刺后脑脊液漏和头痛: 一项前瞻性非侵入性影像学研究。
cerebrospinal fluid leakage magnetic resonance myelography post-dural puncture headache spontaneous intracranial hypotension
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摘要

The spatial distribution and clinical correlation of cerebrospinal fluid leakage after lumbar puncture have not been determined. Adult in-patients receiving diagnostic lumbar punctures were recruited prospectively. Whole-spine heavily T2-weighted magnetic resonance myelography was carried out to characterize post-lumbar puncture spinal cerebrospinal fluid leakages. Maximum rostral migration was defined as the distance between the most rostral spinal segment with cerebrospinal fluid leakage and the level of lumbar puncture. Eighty patients (51 female/29 male, mean age 49.4 ± 13.3 years) completed the study, including 23 (28.8%) with post-dural puncture headache. Overall, 63.6% of periradicular leaks and 46.9% of epidural collections were within three vertebral segments of the level of lumbar puncture (T12-S1). Post-dural puncture headache was associated with more extensive and more rostral distributions of periradicular leaks (length 3.0 ± 2.5 versus 0.9 ± 1.9 segments, P = 0.001; maximum rostral migration 4.3 ± 4.7 versus 0.8 ± 1.7 segments, P = 0.002) and epidural collections (length 5.3 ± 6.1 versus 1.0 ± 2.1 segments, P = 0.003; maximum rostral migration 4.7 ± 6.7 versus 0.9 ± 2.4 segments, P = 0.015). In conclusion, post-dural puncture headache was associated with more extensive and more rostral distributions of periradicular leaks and epidural collections. Further, visualization of periradicular leaks was not restricted to the level of dural defect, although two-thirds remained within the neighbouring segments. 

译文

腰椎穿刺术后脑脊液漏的空间分布及临床相关性尚未确定。前瞻性招募接受腰椎诊断穿刺的成年住院患者。进行了全脊柱重 T2-weighted 磁共振脊髓造影术,以表征腰椎穿刺后脊髓脑脊液漏。最大嘴侧迁移定义为伴有脑脊液漏的最嘴侧脊柱段与腰椎穿刺水平之间的距离。80 名患者 (51 名女性/29 名男性,平均年龄 49.4 ± 13.3 岁) 完成了研究,其中 23 名患者 (28.8%) 患有硬脊膜穿刺后头痛。总的来说,63.6% 的针骨周围渗漏和 46.9% 的硬膜外收集在腰椎穿刺水平的三个椎骨段内 (T12-S1)。硬脑膜穿刺后头痛与更广泛和更多喙侧分布的神经束周渗漏有关 (长度为 3.0 ± 2.5 与 0.9 ± 1.9 段,P = 0.001; 最大喙侧迁移 4.3 ± 4.7 对 0.8 ± 1.7 段,P = 0.002) 和硬膜外收集 (长度 5.3 ± 6.1 对 1.0 ± 2.1 段,P = 0.003; 最大嘴侧迁移 4.7 ± 6.7 与 0.9 ± 2.4 段,P = 0.015)。总之,硬脑膜穿刺后头痛与更广泛和更多喙侧分布的会阴渗漏和硬膜外收集有关。此外,尽管邻近节段仍有 3分之2,但针周渗漏的可视化并不局限于硬脑膜缺损的程度。

Lumbar Puncture

神经 诊疗技术 治疗方法
概述  :  

腰椎穿刺是神经系统常用的一种诊疗技术,从第3~4腰椎或第4~5椎管的蛛网膜下隙穿刺。其对中枢神经系统疾病的诊断和治疗有重要意义。适应证收集和化验分析脑脊液,如判断感染、诊断蛛网膜下隙出血等。神经系统的特殊检查,如测量脑脊液压力和动力学检查,了解椎管有无阻塞等。治疗性穿刺,包括引流脑脊液与注射药物。术前准备①向病人解释手术目的和意义,取得配合。②准备用物:腰椎穿刺包、无菌手套、局麻药(2%利多卡因)、无菌试管、空针、纱布等。③指导病人排空大小便,在床上静卧15~30分钟。术中配合①协助病人取侧

lumbar  英 ['lʌmbə]  美 ['lʌmbɚ] 

释    义   adj. 腰的;腰部的 

  n. 腰椎;腰神经;腰动脉

      lumbar spine 腰椎,腰脊柱

  lumbar vertebra 腰椎

  lumbar vertebrae [医]腰椎

  lumbar puncture [医]腰椎穿刺(等于spinal tap)

例    句   To realize normal stress distribution of lumbar vertebral body. 了解正常人腰椎椎体的应力分布特点。

 

puncture  英 ['pʌŋ(k)tʃə]  美 ['pʌŋktʃɚ] 

释    义    n. (轮胎被扎的)小孔;刺痕;刺伤

  v. 刺穿;(被)戳破;使突然泄气;打断

同根词   adj. punctured 具刻点的;被剌破的

例    句   We seldom discuss the carnage because we don't dare puncture the illusion of safety.  我们很少讨论大屠杀,那是因为我们不敢刺穿安全的假象。

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