自发性硬脊膜外血肿15例诊治分析  

Diagnosis and treatment of spontaneous spinal epidural hematoma(report of 15 cases)

作　　者：周迎春[1] 王旋 邢细红[2] 项宇飞 赵洪洋[1] ZHOU Ying-chun;WANG Xuan;XING Xi-hong;XIANG Yu-fei;ZHAO Hong-yang(Department of Neurosurgery,Union Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430022,China;Department of Neurosurgery,The Second People's Hospital of Jingzhou City,Jingzhou 434000,China)

机构地区：[1]华中科技大学同济医学院附属协和医院神经外科,武汉430022 [2]荆州市第二人民医院神经外科,湖北434000

出　　处：《中国临床神经外科杂志》2020年第6期341-343,347,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨自发性硬脊膜外血肿(SSEH)的临床特点、治疗方法及效果。方法回顾性分析2015年3月至2019年11月收治的15例SSEH的临床资料,保守治疗1例,手术治疗14例:椎板减压血肿清除10例,其中行脊柱固定融合7例,血肿清除后椎板还纳1例,半椎板入路血肿清除3例。结果首次发病9例,两次以上6例。1例保守治疗ASIA分级由入院时C级恢复至出院时E级,后来失访。手术治疗的14例术后随访3个月~4年:4例术前ASIA分级A级中,1例术后随访3个月时仍为A级,随后失访;1例术后2年恢复至D级,2例术后3个月均恢复至E级;术前ASIA分级B^D级的10例术后3个月全部恢复至E级。13例3个月以后随访没有再发病,MRI复查未见复发;X线检查未见脊柱畸形和内固定松动。结论部分SSEH有反复发病的特点,尽早手术可改善病人预后,不同的病例应该个体化选择手术方式。Objective To explore the clinical characteristics,and the diagnostic and therapeutic methods of spontaneous spinal epidural hematoma(SSEH).Methods A retrospective analysis of the clinical data was performed in 15 patients with SSEH who were treated in our hospital from March 2015 to November 2019.Of 15 patients,1 patient received conservative treatment and 14 reveived surgery.Results Of 15 patients,9 patients had single episode and 6 had multiple episodes.The ASIA grade of 1 patient reveiving conservative treatment was recovered from grade C at admission to grade E at discharge,and then the patient was lost to follow-up.The follow-up results of 14 patients(range,3 months to 4 years)receiving surgical treatment showed:1 patients with ASIA grade A preoperatively was still grade A 3 months after the operation,and then lost to follow-up;1 patients with ASIA grade A preoperatively was recovered to grade D 2 years after the operation,2 patients 2 years after operation were recovered to grade E 3 months after the operation;10 patients with ASIA grade B to D before surgery were recovered to grade E 3 months after the operation.Thirteen patients had no recurrence 3 months after the operation.X-ray examination showed no spinal deformity and loose internal fixation.Conclusion Some SSEH have the characteristics of recurrent attacks.Early operation can improve the prognosis of the patients with SSEH,and individual surgery should be chosen for different patients.

关 键 词：自发性硬脊膜外血肿 临床特点 显微手术 

分 类 号：R744.1[医药卫生—神经病学与精神病学]