10例自发性脊髓出血临床特征及预后的影响因素  

Clinical characteristics and prognostic factors for 10 cases of spontaneous spinal cord hemorrhage

作　　者：李后德 宋文丽 李科儒 吴小珂 徐加平[1] 张艳林[1] LI Houde;SONG Wenli;LI Keru;WU Xiaoke;XU Jiaping;ZHANG Yanlin(The Second Affiliated Hospital of Soochow University,Suzhou 215004,China;2417 Hospital of Nuclear Industry,Xi’an 710600,China)

机构地区：[1]苏州大学附属第二医院,江苏苏州215004 [2]核工业四一七医院,陕西西安710600

出　　处：《中国实用神经疾病杂志》2024年第3期283-287,共5页Chinese Journal of Practical Nervous Diseases

基　　金：江苏省重点研发计划项目(编号:ZDXK202217)。

摘　　要：目的分析自发性脊髓出血患者临床症状、影像学及诊治过程,探讨影响其预后的主要因素。方法回顾性分析2015—2023年收治的10例自发性脊髓出血患者的临床资料,并联合应用JOA评分和ASIA损伤分级用于脊髓病变的评估、mRS量表评价患者预后。结果9例患者出现神经根性疼痛,10例均伴不同程度运动、感觉、自主神经受累表现。5例病因考虑为脊髓血管畸形,5例病因不明。3例患者行减压手术治疗,1例术前ASIA分级A级,末次随访仍为A级,另2例ASIA分级由术前B、C级恢复至D级;7例患者内科保守治疗,其中3例入院ASIA分级A级,末次随访1例恢复至D级,另2例仍为A级,其余4例入院ASIA分级B~D级,末次随访2例恢复至E级,2例恢复至D级。JOA评分为轻度、中度及重度残疾的患者恢复率依次72.2%、52.8%、2.9%。结论脊髓血管畸形是脊髓出血最常见病因,CT阴性不能排除脊髓出血,MRI对其诊断价值较高,对有适应证者首选手术治疗,严重神经功能障碍者手术或保守治疗预后均较差,脊髓出血早期JOA评分及mRS评分对其预后评估有指导意义。Objective To analyze the clinical symptoms,imaging and related hematological examination results,diagnosis and treatment of patients with spontaneous spinal cord hemorrhage,and to inuestigate the main factors affecting the prognosis.Methods The clinical data of 10 patients with spontaneous spinal cord hemorrhage from 2015 to 2023 were analyzed retrospectively.JOA score and ASIA injury grade were used to evaluate myelopathy and mRS scale to evaluate the prognosis of patients with spontaneous spinal cord hemorrhage.Results Nerve root pain occurred in 9 cases,and motor,sensory and autonomic nerve involvement were found in 10 cases.The etiology of 5 patients was considered to be spinal vascular malformation,and the other 5 cases was unknown.Three patients underwent decompression surgery.One patient was ASIA grade A before operation,and the last follow-up was still grade A,while the other two patients’ASIA grade recovered from preoperative grade B and C to grade D.Seven patients were treated conservatively in internal medicine,of which 3 cases were admitted to ASIA grade A,1 case recovered to grade D,the other 2 cases were still grade A,the other 4 cases were admitted to ASIA grade B-D,2 cases recovered to grade E and 2 cases recovered to grade D at the last follow-up.The recovery rate of patients with mild,moderate and severe disability according to JOA score was 72.2%,52.8%,2.9%,respectively.Conclusion Spinal vascular malformation is the most common cause of spinal cord hemorrhage.CT negative can not rule out spinal cord hemorrhage.MRI is of high diagnostic value for spinal cord hemorrhage.Surgical treatment is the first choice for patients with adaptation,and the prognosis of patients with severe neurological dysfunction is poor by operation or conservative treatment.JOA score and mRS score in the early stage of spinal cord hemorrhage have guiding significance for the evaluation of prognosis.

关 键 词：脊髓血管病 自发性出血 预后 临床特征 影响因素 

分 类 号：R743.34[医药卫生—神经病学与精神病学]