血肿清除术联合持续冲洗引流治疗腰椎术后症状性硬膜外血肿的临床疗效  

Efficacy of hematoma clearance combined with continuous irrigation and drainage on lumbar postoperative symptomatic spinal epidural hematoma

作　　者：李骁腾 张怀栓[1] 吕丰姿 张华[1] 郭小伟[1] 潘玉林[1] 时晓华 梅伟[1] LI Xiaoteng;ZHANG Huaishuan;LYU Fengzi;ZHANG Hua;GUO Xiaowei;PAN Yulin;SHI Xiaohua;MEI Wei(Department of Spinal Surgery,Zhengzhou Orthopedic Hospital,Zhengzhou,Henan 450002,China;Department of Anesthesiology and Perioperative Medicine,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]郑州市骨科医院脊柱外科,河南郑州450002 [2]河南省人民医院,郑州大学人民医院麻醉与围手术期医学科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2024年第6期595-600,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省科技攻关计划项目(222102310718)。

摘　　要：目的 观察血肿清除术联合持续冲洗引流治疗腰椎术后症状性硬膜外血肿(symptomatic spinal epidural hematoma, SSEH)的疗效及安全性。方法 2017年1月—2023年3月郑州市骨科医院诊治行腰椎后路椎管减压椎间植骨融合内固定术且术后发生SSEH患者15例,确诊SSEH后6~12 h紧急行血肿清除术联合持续冲洗引流治疗。记录手术前、后白细胞计数、血小板计数、血红蛋白、白蛋白、D-二聚体、C反应蛋白、红细胞沉降率;手术前、后采用疼痛视觉模拟评分(VAS)评价腰部和下肢疼痛程度,采用Oswestry功能障碍指数(ODI)评价腰椎功能;随访7~18个月,术前及末次随访时采用美国脊髓损伤协会(ASIA)分级评估脊髓神经功能损伤程度。结果 15例患者均手术顺利,术后切口愈合良好后出院或转入康复科行康复治疗。15例患者中SSEH发生于术后1周内13例,术后7~10 d 2例;发生于拔除引流管前3例,发生于拔除引流管后12例;临床症状为下肢疼痛麻木12例,下肢肌力减弱8例,大小便障碍3例,腰背部切口肿痛无法平卧9例;ASIA分级B级2例,C级5例,D级8例;术中发现椎管内静脉丛活动性出血2例,血凝块堵塞引流管口2例,引流管在切口内折叠1例,大量血凝块附着于止血材料表面压迫硬膜但无明显出血点10例。患者白细胞计数术后2周均低于术前、术后1 d、术后1周(P<0.05),术前、术后1 d、术后1周比较差异无统计学意义(P>0.05);血小板计数术后1、2周均高于术前、术后1 d(P<0.05),术后1周与术后2周、术前与术后1 d比较差异均无统计学意义(P>0.05);白蛋白术后1 d低于术前(P<0.05),术后1、2周均高于术后1 d(P<0.05),术前、术后1周、术后2周比较差异无统计学意义(P>0.05);D-二聚体术后1 d、术后1周、术后2周均低于术前(P<0.05),术后1、2周均低于术后1 d(P<0.05),术后1周与术后2周比较差异无统计学意义(P>0.05);C反应蛋白术后1、2周均低于术后1 d(P<0.05),术Objective To observe the clinical efficacy and safety of hematoma clearance combined with continuous irrigation and drainage in the treatment of symptomatic spinal epidural hematoma(SSEH)after lumbar spine surgery.Methods Fifteen patients with SSEH after posterior lumbar spinal canal decompression,interbody fusion and internal fixation were treated in Zhengzhou Orthopedic Hospital from January,2017 to March,2023.All patients underwent emergency hematoma removal surgery combined with continuous irrigation and drainage within 6-12 h after diagnosis of SSEH.The preoperative and postoperative white blood cell count,platelet count,hemoglobin,albumin,D-dimer,C-reactive protein and erythrocyte sedimentation rate were recorded.Before and after surgery,the visual analogue scale(VAS)was used to evaluate the degree of pain in the lower back and lower limbs,and the Oswestry Disability Index(ODI)was used to evaluate the lumbar function.After follow-up for 7-18 months,the American Spinal Injury Association(ASIA)grading was used to evaluate the degree of spinal cord nerve function damage before surgery and at the latest follow-up.Results All patients underwent surgery smoothly and were discharged or transferred to the rehabilitation department for rehabilitation treatment after good postoperative incision healing.Among 15 patients,SSEH developed within 1 week after surgery in 13 patients,and 7 to 10 d after surgery in 2;developed before the removal of the drainage tube in 3 patients,and after the removal of the drainage tube in 12.The clinical symptoms included lower limb pain and numbness in 12 patients,weakened lower limb muscle strength in 8,urinary and bowel dysfunction in 3,and unable to lie down due to incision swelling and pain.The ASIA was grade B in 2 patients,grade C in 5,and grade D in 8.During surgery,2 patients were found active bleeding from the venous plexus within the spinal canal,2 were found blood clots blocking the opening of the drainage tube,1 was found the drainage tube folded within the incision,and 10 we

关 键 词：腰椎手术 症状性硬膜外血肿 血肿清除术 持续冲洗引流 

分 类 号：R687.3[医药卫生—骨科学]