自发性硬脊膜外血肿的临床特点及预后影响因素分析

CLINICAL FEATURES OF SPONTANEOUS SPINAL EPIDURAL HEMATOMA AND INFLUENTIAL FACTORS OF ITS PROGNOSIS

目的探讨自发性硬脊膜外血肿（spontaneous spinal epidural hematoma,SSEH）的临床特点以及预后影响因素。方法1998年9月-2006年10月,收治SSEH患者23例。男10例,女13例;年龄10-69岁。神经功能障碍按ASIA分级：A级7例,B级2例,C级4例,D级9例,E级1例。发病至出现明显神经功能障碍时间：〈12h12例,12-24h2例,24-48h3例,〉48h6例。均经MRI检查或病理学检查确诊。17例采用手术治疗,6例采用以甲基强的松龙（80-100mg/d）为主的非手术治疗。回顾患者病史、实验室检查、放射学诊断、病理学检查结果及治疗方法,分析以上因素对患者预后的影响。结果23例随访3个月,恶化1例,无进展8例,改善9例,痊愈5例。性别对预后影响无统计学意义（P〉0.05）;病程进展越快,血肿所覆盖的脊髓节段越多,患者的预后越差（P〈0.05）;神经损害越轻,预后越好（P〈0.01）。手术治疗17例中,预后评分为1分1例,2分5例,3分6例,4分5例;手术前时间与预后的相关系数为0.056（P〉0.05）。非手术治疗6例中,预后评分2分及3分各3例。结论SSEH是一种罕见疾病,其预后受患者神经功能状态、病程进展时间、脊髓是否合并水肿及硬膜外血肿体积等因素影响。此病以手术治疗为主,且宜早期进行,防止脊髓功能进一步恶化。非手术治疗只适用于脊髓功能在早期恢复的患者。

Objective To explore the clinical features of spontaneous spinal epidural hematoma （SSEH） and to find out factors influencing its prognosis. Methods From September 1998 to October 2006, 23 patients with SSEH （10 males and 13 females） were treated. Their ages ranged from 10 to 69 years. The primary neurological status were classified as grade A in 7 patients, t3 in 2 patients, C in 4 patients, D in 9 patients and E in 1 patients according to ASIA grading system. The progressive intervals of their symptoms were divided as four period： less than 12 hours （12 patients）, 12 to 24 hours（2 patients）, 24 to 48 hours（3 patients） and more than 48 hours（6 patients）. SSEH was diagnosed by MRI or by histopathological examination. The cases history, laboratory examination, radiological image, treatment, pathological result and prognosis were recorded and analyzed after 3 month. Results In 23 patients, there were 1 case of deterioration, 8 cases of no change, 9 cases of improvement and 5 cases of complete recovery. The gender had no correlation with prognosis（P〉0. 05）. In the patients who had shorter progressive interval and more severe edema of spinal cord, the prognosis was worse （P 〈 0, 05）, In the patients who had mild neurological deficit, the prognosis was good （P〈0. 01）. In 17 patients undergoing surgery, the scores for prognosis was 1 point in 1 case, 2 points in 5 cases, 3 points in 6 cases and 4 points in 5 cases, the operation time had no correlation with prognosis（r= 0.056, P〉0.05）, In 6 patients undergoing conservative treatment, the scores for prognosis were 2 points and 3 points in 3 cases respectively. Conclusion Prognosis of patient with SSEH is influenced by his primary neurological status, progressive interval, spinal edema and size of hematoma. The major treatment is surgical evacuation of hematoma as early as possible to break the aggravation of spinal function, Conservative treatment is not considered unless the neurological defects recovered in the early period.