改良单开门椎板成形术治疗儿童自发性椎管内硬膜外血肿2例分析

An analysis of 2 cases of children with spontaneous spinal epidural hematoma treated by modified single-door laminoplasty

自发性椎管内硬膜外血肿(SSEH)指不明原因引起的椎管内硬膜外腔内异常积血,该病儿童发病率较低。延迟的手术减压可能造成患儿严重的神经功能障碍甚至终身瘫痪。椎板切除减压血肿引流是治疗SSEH的首选方法,但该方法创伤大,破坏后柱稳定性,在儿童病例中的应用尚存争议。本文报道了2例SSEH儿童病例,最初症状为颈部疼痛或肢体麻木无力,血肿经MRI已证实。入院完善检查后急诊行改良单开门椎板成形血肿引流术,术后患儿颈痛症状消失,神经功能缺损恢复,随访3个月未见明显脊柱后凸畸形。本文旨在强调改良单开门椎板成形术在治疗儿童SSEH中的潜在优势。

Spontaneous spinal epidural hematoma(SSEH)is an unexplained abnormal accumulation of blood in the spinal epidural space,and the disease has a lower incidence in children.Delayed surgical decompression can lead to severe neurological impairment or even lifelong paralysis.Decompression hematoma drainage by laminectomy is the preferred treatment for SSEH.However,the application of this method in children cases is still controversial because it is highly invasive and damages the stability of posterior column.Two cases of SSEH children with initial symptoms of neck pain or limb numbness and weakness were reported.The hematoma was confirmed by MRI.After complete examination at admission,hematoma drainage with modified single open door laminoplasty was performed in the emergency department.Postoperative symptoms of neck pain disappeared.Recovery of neurological impairment.No obvious kyphosis deformity was found during 3 months of follow-up.This article aims to highlight the potential advantages of improved single-door laminoplasty in the treatment of SSEH in children.