自发性椎管内出血的外科诊治

Surgical Management of Spontaneous Hematorrhachis

目的探讨自发性椎管内出血的病因、部位、临床表现、MRI特征、治疗和预后的相关因素。方法武汉同济医院自2000年1月至2008年1月共收治的此类患者13例,回顾性分析了本组病例的发病、术前神经功能状态、手术时机、术后神经功能恢复情况,通过日本骨科协会(JOA)评分和改善指数,对影响预后的因素进行了统计学分析。结果从发病到手术时间间隔4h～14d不等,术后没有出现新的并发症。术前JOA评分平均为3.38,术后JOA评分平均为11.38,平均改善指数为61.69%。不完全性运动障碍的改善指数手术前后差异有显著性意义(P<0.05),24h以内手术患者和超过24h手术患者改善指数差异有显著性意义(P<0.05)。结论自发性椎管内出血是一种少见的神经外科急诊,一旦发生可导致脊髓功能的严重损害。MRI是有效的确诊手段,硬膜外的血肿一经确诊,应立即行椎板切除+血肿清除术。患者的预后与术前神经功能障碍程度及发病到手术的时间间隔密切相关,术前神经功能越好,预后也越好,从发病到手术时间间隔越短,预后越好。

Objective To explore the etiology, location, clinical presentation, MRI manifestations, treatment and prognosis of spontaneous hematorrhachis. Methods In 13 patients who underwent hematoma removal from January 2000 to January 2008, the presentation, the preoperative neurological status, the operative time interval and neurological outcome were reviewed by using the Japanese Orthopaedics Association （JOA） score. Results All patients underwent operations from 4 h to 14 days. There was no complication related to the surgical operations. In all cases, the recovery scale was improved after surgical operation. The average score of the preoperative JOA was 3.38, but that was increased to 11.38 after surgery and the average recovery scale was 61.69 %. There was a statistically significant difference in the incomplete neurological injury before and after operation （P〈0.05）. The neurological outcome was good in those cases that had their hematoma removed within 24 h （P〈 0.05）. Conclusion Spontaneous hematorrhachis presents only rarely, hut it can leave serious sequelae when it does occur. The optimal diagnostic method is MR imaging. The standard management for SSEH is to evacuate the hematoma and perform spinal cord decompression by an emergency operation. The neurological outcome is related with the preoperative status of the neurological deficit and the operative time interval. The better the preoperative neurological status is, the better the neurological outcome is after the surgical operation.