儿童自发性硬脊膜外血肿8例临床分析  

Spontaneous spinal epidural hematoma in children: a report of 8 cases

作　　者：于增鹏[1] 梁平[1] 李映良[1] 翟瑄[1] 周渝冬[1] 李禄生[1] 夏佐中[1] 

机构地区：[1]重庆医科大学附属儿童医院神经外科,儿童发育疾病研究省部共建教育部重点实验室,儿科学重庆市重点实验室,重庆市儿童发育重大疾病诊治与预防国际科技合作基地,重庆400014

出　　处：《第三军医大学学报》2016年第20期2283-2286,共4页Journal of Third Military Medical University

基　　金：国家临床重点专科建设项目(国卫办医函[2013]544)~~

摘　　要：目的 总结儿童自发性硬脊膜外血肿（spontaneous spinal epidural hematoma,SSEH）的病因、临床特点、治疗及预后。方法 回顾性分析重庆医科大学附属儿童医院神经外科8例SSEH患儿的临床资料。6例年长儿以颈背部疼痛为首发症状,1例婴幼儿以颈部活动受限为首发症状,数小时或数天后出现神经功能障碍;1例婴幼儿以肢体无力为首发症状。发病至手术时间为1-15 d;均行硬脊膜外血肿清除术。结果 MRI能准确显示病变,血肿位于颈胸段背侧,累及4-9节段。5例神经功能完全恢复,2例部分恢复,1例无变化。3例明确病因为血管畸形。结论 儿童SSEH的早期诊断主要依据临床特征和MRI,一旦确诊,尽早手术清除血肿。及早诊断及治疗是改善预后的关键。Objective To summarize the etiology, clinical characteristics, treatment protocol and prognosis of spontaneous spinal epidural hematoma （SSEH） in children. Methods Clinical data of 8 SSEH children collected at our department during 2008 and 2014 were retrospectively studied. Six cases of elder children had initial symptom of neck and back pain. One infant showed limited neck movement which might progress to nerve dysfunction within a few hours or days, and another infant had limb weakness. The time from onset to surgery was 1 to 15 d. All cases underwent surgical removal of spinal epidural hematoma. Results Magnetic resonance imaging （MRI） showed that the hematomas were located at the dorsal spine of cervicothoracic region, involving 4 to 9 vertebrae. Complete and partial neurological recovery were found in 5 and 3 patients, respectively. Two patients were recovered and 1 patient had no change. 3 cases were caused by vascular malformation. Conclusion Early diagnosis of SSEH in children mainly relies on clinical characteristics and MRI examination. Urgent removal of hematoma after rapid diagnosis is the key to achieve better prognosis of children with SSEH.

关 键 词：硬脊膜外血肿 自发性 儿童 诊断 

分 类 号：R651.15[医药卫生—外科学] R722.143[医药卫生—临床医学]