急性自发性硬脊膜外血肿的诊断和治疗

Diagnosis and microsurgery of acute spontaneous spinal epidurai hematoma

目的分析和探讨急性自发性硬脊膜外血肿（ASSEH）的临床特征、诊断和治疗。方法对5例经手术证实的ASSEH病例的诊断和显微手术治疗进行回顾性分析。5例患者主要临床症状为突发颈肩部／腰背部剧痛，并迅速出现迟缓性瘫痪和植物神经功能障碍。MRI检查均表现为椎管内硬膜外条状或梭形病灶，边界清楚，未见强化。急诊在显微镜下行后路椎管探查椎板切除血肿清除术。结果所有患者手术经过顺利，术中见血肿位置与MRI提示的一致，清除褐色胶冻样血肿5．15ml，显微镜下未见蛛网膜下隙和脊髓异常。按照国际脊髓损伤神经分类标准评分，术后11-30d神经功能从术前的B、C级均恢复到E级，未有并发症发生。随访1～6个月均未见异常。结论结合临床症状和MRI可提高ASSEH正确诊断率，而术前行数字减影血管造影（DSA）并非必要。急诊显微神经外科手术是治疗症状性ASSEH的有效手段，术后DSA有助于排除脊髓血管畸形。

Objective To investigate the diagnosis and the effect of microsurgery in patients with acute spontaneous spinal epidural hematoma （ASSEH）. Method Five patients with ASSEH treated with microsurgery and confirmed pathologically were retrospectively analyzed. Results The main clinical presentations were root pain and palsy. The main manifestations of MRI were long-segment epidural lesion of high intensity in T1 and T2-weighted images without enhancement. With the microsurgery system, laminectomy via posterior approach and hematoma removal were successfully undergone with full recovery in all eases. Conclusions MRI assisted with the main clinical symptoms may aid preoperative diagnosis in symptomatic ASSEH. Microsurgery is an effective method for treating ASSEH. Postoperative （rather than preoperative） spinal DSA is advantageous for exclusion of spinal vascular malformation in treating ASSEH.