自发性硬脊膜外血肿发病的解剖因素探讨

Analysis on the anatomic factors in the etiology of spontaneous spinal epidural edema

目的探讨自发性脊髓硬膜外血肿（SSEH）发病中的解剖学因素。方法分析1995-2010年10例接受手术的SSEH患者临床表现、诊治经过及病理结果。结果10例患者均行随访，时间6-18个月，手术治疗的患者中2例患者受累肢体神经功能完全恢复；8例患者除大小便功能不同程度改善外，肢体的运动感觉功能无明显恢复。术中所见并结合病理检查，血肿组织者10例，血管畸形者。结论SSEH病因不明确，多发病急，发展迅速，预后差。自发性的出血可能与硬脊膜外隐匿性血管瘤或静脉血管扩张等有关，解剖学因素在发病中起到重要作用。

Objective To explore the etiology, clinical presentation and treatment of spontaneous spinal epidural hematoma （SSEH）. Methods 10 cases presented with paraplegia were diagnosed as SSEH between 1995 to 2010 and received surgical operation. The characteristics of onset, clinical presentation, diagnosis, treatment and results of follow-up were analyzed. Results Followed-up for 6-18 months, 2 cases resulted in good recovery of nervous disfunction, while 8 cases showed no significant amelioration in spinal cord function. Conclusions The etiology of SSEH remains indefinite and the prognosis is usually disappointed. Permanent spinal cord disfunction is seemly inevitable in most cases. Some anatomic reasons, such as epidural vascular malformation, may play an important role in the outbreak of SSEH.