颈椎前路术后硬膜外血肿的相关因素分析及防治

Risk factors,prevention and treatment of spinal epidural hematoma following anterior cervical operation

目的:探讨颈椎前路术后发生硬膜外血肿的相关因素及其防治措施。方法:1998年1月～2006年12月共行颈椎前路手术1821例,10例术后出现了颈椎硬膜外血肿,并通过再次行血肿清除减压术得到证实。回顾分析该10例患者出现硬膜外血肿的相关因素,统计分析确诊时段、清除血肿的时段与末次随访神经功能恢复情况之间的关系。结果:10例患者出现硬膜外血肿的相关因素分别是:凝血功能障碍5例,伤口引流障碍2例,血管瘤1例,不明原因2例。经Spearman等级相关分析,确诊时ASIA等级与确诊时段呈负相关(Spearman等级相关系数=-0.85),末次随访神经功能恢复情况与手术时段呈负相关(Spearman等级相关系数=-0.93)。结论:术前凝血功能障碍及伤口引流障碍是颈椎前路术后硬膜外血肿发生的高危因素,早期发现并尽快再次手术清除血肿利于患者神经功能的恢复。

Objective：To explore the correlative factors,prevention and treatment of spinal epidural hematoma （SEH） following anterior cervical operation.Method：A retrospective study was done on 1821 cases who underwent anterior cervical operation from January 1998 to December 2006,of which 10 cases had SEH that was verified by hematoma debridement and decompression.The risk factors of SEH were reviewed statistically, and the relationship among interval from initial symptom onset to diagnosis,interval from symptom onset to surgery and neurological outcome were analyzed respectively.Result：The risk factors among the 10 cases of SEH were coagulation malfunction in 5 eases,obsttueted drainage in 2,hemangioma in 1 and unknown causes in 2.The ASIA grade of maximum deficit negatively correlated with interval from initial symptom onset to diagnosis （Spearman rank correlation coefficient=-0.85）.The follow-up ASIA grade negatively correlated with interval from symptom onset to surgery （Spearman rank correlation coefficient =-0.93 ）.Conclusion ： Coagulate function and obstructed drainage are important risk factors associated with SEH following anterior cervical operation.Early diagnosis and hematoma debridement must be performed as soon as possible once neurological deficit is found.