自发性椎管内硬脊膜外血肿的诊断和治疗  

Diagnosis and treatment of spontaneous spinalepidural hematomas

作　　者：韩芸峰[1] 王振宇[1] 陈晓东[1] 

机构地区：[1]北京大学第三医院神经外科,100191

出　　处：《中国临床神经外科杂志》2014年第8期452-454,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的总结自发性椎管内硬脊膜外血肿（SSEH）诊断和治疗的经验。方法回顾性分析10例SSEH患者的临床资料,其中手术治疗7例（术前Frankel分级B级4例,C级2例,D级1例）,保守治疗3例（术前Frankel分级E级）。结果 7例术后未出现并发症,术后复查MRI显示血肿清除;术后病理组织学结果示,4例为单纯血凝块,1例血凝块伴炎性细胞浸润,1例符合血管瘤出血,1例血凝块含较多血管伴血管壁肌层发育不良。所有患者随访1∽40个月,手术治疗7例中5例Frankel分级恢复至E级,2例恢复至D级;3例保守治疗患者复查MRI示血肿均吸收,Frankel分级维持E级。结论 SSEH起病急,进展快;治疗以手术椎板减压＋清除血肿为主要方法,部分患者可考虑选择保守治疗。Objective To summarize the experience in diagnosing and treating spontaneous spinal epidural hematoma （SSEH）. Method The clinical data of 10 patients with SSEH were analyzed retrospectively, including the clinical manifestation, imaging data and therapeutic method and effect. Of 10 patients with SSEH, 7 were treated surgically and 3 conservatively. The neurological functions before and after the treatment were assessed by Frankel neurological function grading. Results The following up from 1 to 40 months showed that of 7 patients undergoing the surgery through posterior midline approach for evacuation of SSEH, 5 had Frankel grade E neurological function and 2 the grade D. No complications were observed during and after the operation. The postoperative MRI showed that the SSEH were evacuated. Following up by MRI showed that the hemotomas were absorbed after the conservative treatment in 3 patients, who had Frankel grade E neurological function during the following up. Conclusions SSEH has characteristics such as acute onset and rapid progression. The laminectomy and evacuation of hemotoma for the decompression is usually the main method to treat SSEH. However, conservative treatment is also feasible in the selected patients with SSEH.

关 键 词：自发性椎管内硬膜外血肿 诊断 治疗 

分 类 号：R744.1[医药卫生—神经病学与精神病学] R616.2[医药卫生—临床医学]