急性发病的椎管内硬膜外占位的治疗策略及疗效评估

Acute spinal epidural space-occupying: treatment strategies and efficacy evaluation

目的:探讨突然发病来院急诊的椎管内硬脊膜外占位的早期诊断、急诊处理及治疗效果。方法:2008至2010年收治的177例脊髓脊柱疾病患者中,10例患者急性发病来院急诊,通过手术切除占位。随访3个月～2年,应用美国脊髓损伤学会(ASIA)评分标准对患者进行评分,并行统计学分析。结果:占位原因:血肿7例,脓肿2例,肿瘤1例。所有患者经手术切除椎管内占位,临床症状均有所改善,评分升高。术后10 d评估,运动评分平均上升30.7分,感觉评分平均上升65.8分。预后和病变的脊髓节段、术前激素治疗效果以及病程有明显关系,同时术后积极的康复治疗对远期预后也十分关键。结论:急性发病的椎管内硬脊膜外占位需要在仔细查体的基础上快速诊断,MRI有确诊价值;手术可能对解除脊髓压迫有意义,为脊髓恢复创造条件;病变位于胸椎第4节段附近者预后往往较差,颈髓和腰髓的病变相对预后较好。

Objective： To investigate early diagnosis, emergent treatment and therapeutic effect of acute onset spinal epidural space-occupying. Methods： The data included 10 patients（6 male and 4 female, averaging 46 y） who had acute spinal epidural space-occupying in different spinal segment was collected from 2008 to 2010, follow- ups lasting three months to two years were reviewed. Preoperative patients and postoperative patients were scored by ASIA standard, respectively, followed by the statistical analysis of the scores. Results： The causes of acute spinal epidural space-occupying were hematoma in 7 cases, abscess in 2 cases, tumor in 1 case. Clinical symptoms were improved and the scores raised after emergency surgery： motor scores raised 30. 7 points and sensory scores 65.8 points on average. Prognosis was closely related with the timing of surgery, oppressed segments of spinal cord, preoperative hormone treatment and the disease course, also the active rehabilitation after surgery was critical to the long-term prognosis. Conclusions： Acute spinal epidural space-occupying disease is diagnosed based on careful physical examination and imaging （MRI and three-dimensional reconstruction of CT）. Emergency surgery, useful for spinal cord recovery, can remove the space-occupying and relieve spinal cord compression. Different oppressed segments of spinal cord affects prognosis, for example, oppressed thoracic segment IV often had a poor prognosis, on the contrary oppressed cervical and lumbar spine had a better one.