自发性硬脊膜外血肿的诊断与治疗

Diagnosis and treatment of spontaneous spinal epidural hematoma

目的 探讨自发性硬脊膜外血肿的出血原因、临床表现、MRI特征、治疗及预后相关因素。 方法 结合相关文献 ,回顾性分析 6例自发性硬脊膜外血肿 (SSEH)的发病机制、临床特征、术前神经功能状态及发病到手术的时间间隔与预后因素。 结果 SSEH好发于年轻患者 ,多急性起病。MRI显示椎管后方或后外方半月形占位影。患者预后与术前神经功能状态及发病到手术的时间间隔密切相关 ,与年龄、血肿部位、血肿大小无关。患者术前的神经功能状态越好预后越佳 ,发病到手术的时间间隔越短预后越好。 结论 MRI检查是诊断本病最佳方法。

Objective To evaluate the cause of hemorrhage of spontaneous spinal epidural hematoma (SSEH), its clinical manifestations, MR images, treatment, and prognosis. Methods Based on literature review, we retrospectively analysed 6 patients with SSEH in terms of pathogenic mechanism, clinical features, neurological function, and the interval between the onset of SSEH and surgery and prognosis. Results SSEH was liable to occur in young people, and most of cases were acute. MR imaging showed semilunar space occupying mass in the posterior or posteriolateral part inside the spinal canal. The outcome was closely related to the interval between the onset and surgery, whereas it was not related to age, site and size of the hematoma. The better neurological state before surgery and the shorter interval between onset and operation, the better outcome in such patients. Conclusions SSEH may be originated from venous bleeding. The process at onset and clinical manifestation depends on the blood supply of the spinal cord. The optimal diagnostic method is MR imaging. Decompression of spinal cord in time is the key procedure for improving the patients' outcome.