成人自发性椎管内出血的临床分析

Clinical analysis of spontaneous intraspinal hemorrhage in adults

目的探讨成人自发性椎管内出血的临床特点、治疗方案及预后。方法回顾性分析2012年1月至2021年5月遵义医科大学第一附属医院、第三附属医院脊柱外科35例自发性椎管内出血患者的临床症状、体征、影像学资料、出血原因、治疗方式及随访情况等。结果35例患者中硬脊膜外出血30例,髓内出血5例。血肿位于颈椎10例、胸椎14例、腰椎3例,颈胸椎3例,胸腰椎5例。采取手术治疗23例、保守治疗9例、拒绝手术3例。所有病例均随访,末次随访时神经功能改善率为87.5%。术前美国脊髓损伤协会(ASIA)分级为A级的8例患者术后改善率为50%。结论ASIA分级A~C级建议急诊行减压治疗,神经损伤轻或进行性好转者可保守治疗。干预时神经功能障碍程度越重,预后越差。

Objective To investigate the clinical features,treatment options,and prognosis of spontaneous intraspinal hemorrhage in adults.Methods The clinical symptoms,signs,imaging data,causes of hemorrhage,treatment methods,and follow-up of 35 patients with spontaneous intraspinal hemorrhage who were admitted from January 2012 to May 2021 in the Department of Spinal Surgery,the First Affiliated Hospital of Zunyi Medical University and the Third Affiliated Hospital of Zunyi Medical University were retrospectively analyzed.Results There were 30 cases of dural hemorrhage and 5 cases of intramedullary hemorrhage.Hematoma was located in cervical vertebrae in 10 cases,thoracic vertebrae in 14 cases,lumbar vertebrae in 3 cases,cervical thoracic vertebrae in 3 cases,and thoracolumbar vertebrae in 5 cases.Surgical treatment was performed in 23 cases,conservative treatment in 9 cases,and refusal of surgery in 3 cases.All cases were followed up,and the improvement rate of neurological function was 87.5%at the last follow-up.The postoperative improvement rate of 8 patients with American Spinal Injury Association(ASIA)grade A was 50%.Conclusion ASIA grade A to C is recommended for emergency decompression,and conservative treatment is recommended for mild or progressive improvement of nerve injury.The more severe the neurological dysfunction,the worse the prognosis.