自发性脊髓硬脊膜外血肿临床特征及手术治疗效果观察  

Clinical feature and surgical outcome of spontaneous spinal epidural hematoma

作　　者：赵晓蕾 冯亚非 赵雄 雷伟 吴子祥 ZHAO Xiaolei;FENG Yafei;ZHAO Xiong;LEI Wei;WU Zixiang(Department of Ortho pedics,Xijing Hospital of Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学西京医院骨科,西安710032

出　　处：《中华实用诊断与治疗杂志》2020年第10期990-992,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金面上项目(81772310)。

摘　　要：目的总结自发性脊髓硬脊膜外血肿临床特征,分析影响手术治疗效果的因素。方法 15例自发性脊髓硬脊膜外血肿患者,均行手术治疗并随访1~2年。分别于术前、术后及末次随访时行日本骨科协会(Japanese Orthopedic Association, JOA)评分,计算神经功能改善率;分析手术时间、术前JOA评分对治疗效果的影响。结果 15例血肿位于下颈椎节段9例,上胸椎4例,颈胸交界区(C6~T1、C7~T2)2例。术后、末次随访时JOA评分[(6.20±1.98)、(13.87±3.62)分]均高于术前[(1.73±1.16)分](P<0.05);末次随访时神经功能改善率[(80.95±2.02)%]高于术后[(33.64±10.82)%](P<0.05)。早期(截瘫后<24 h)手术治疗者术后、末次随访时神经功能改善率[(42.27±4.65)%、(98.53±4.16)%]高于晚期(截瘫后≥24 h)手术治疗者[(23.80±5.97)%、(60.87±1.51)%](P<0.001)。术前神经功能完全损伤者(JOA评分0分)术后、末次随访时神经功能改善率[(32.68±1.10)%、(79.74±2.18)%]与不完全损伤者(JOA评分>0分)[(35.09±1.13)%、(82.78±2.43)%]比较差异无统计学意义(P>0.05)。结论对自发性脊髓硬脊膜外血肿患者,早期行手术治疗清除血肿,可解除神经压迫,改善神经功能。Objective To summarize the clinical characteristics of spontaneous spinal epidural hematoma and analyze the influencing factors for the surgical outcome. Methods Fifteen patients with spontaneous spinal epidural hematoma received surgery and 1-to 2-year follow-up. The Japanese Orthopedics Association(JOA) score was used to calculate the improvement rate of neurological function before and after surgery as well as at final follow-up. The influences of operation lasting time and preoperative JOA on the surgical outcome were analyzed. Results The hematoma was located at low cervical vertebra in 9 patients, at the upper thoracic vertebra in 4, and at the neck-thoracic junction(C6-T1, C7-T2) in 2. JOA score was significantly higher after surgery(6.20±1.98) and at final follow-up(13.87±3.62) than that before surgery(1.73±1.16)(P<0.05), and the improvement rate of neurological function was higher at final follow-up((80.95±2.02)%) than that after surgery((33.64±10.82)%)(P<0.05). The improvement rates of neurological function were higher after relieving nerve compression by early clearance of hematoma(<24 h)((42.27±4.65)%) and at final follow-up((98.53±4.16)% than those by late clearance of hematoma(≥24 h)((23.80±5.97)%),(60.87±1.51)%)(P<0.001). There were no significant differences in the improvement rates of neurological function after surgery and at final follow-up between patients with complete neurological impairment(JOA=0)((32.68±1.10)%,(79.74±2.18)%) and patients with partial neurological impairment(JOA>0)((35.09±1.13)%,(82.78±2.43)%)(P>0.05). Conclusion Early hematoma clearance could relieve nerve compression and improve neurological function in patients with spontaneous spinal epidural hematoma.

关 键 词：脊髓硬脊膜外血肿 自发性 日本骨科协会评分 神经功能损伤 

分 类 号：R651.2[医药卫生—外科学]