腰椎间盘突出症术后硬脊膜外血肿的诊治与预防

Spinal Epidural Hematoma following Operation of Lumbar Disc Herniation

目的:结合典型病例分析和探讨腰椎间盘突出症手术后硬膜外血肿形成的原因、诊断处理及预防问题。方法:19582002年7月,共手术治疗腰椎间盘突出症8510例,术后发生硬脊膜外血肿12例,发生率为0.14％,发生时间为术后26h。结果:全部病例在血肿诊断后0.52h内行椎管探查、止血及血肿清除术。术中发现,椎管内静脉出血是血肿形成的主要原因,全部病例在血肿清除术后14h内运动、感觉功能完全恢复。结论:术中止血彻底,引流通畅,术后严密观察,及时手术探查,是预防及治疗硬脊膜外血肿的根本措施。

Objective: To investigate the reason of occurrence of the spinal epidural hematoma following the operation of lumbar disc herniation and discuss its diagnosis, treatment and prevention. Methods:From 1958 to 2002.7,8510 cases of lumbar disc herniation were treated with operation in our department. In 12 cases arose the spinal epidural hematoma following operation. The incidence rate was 0.14%. Results: Incomplete hemostasia was the main reason of occurrence of the spinal epidural hematoma. The close observation following the operation was the key to the early diagnosis of the spinal epidural hematoma. Immediately surgical exploration of hemostasia and removal of the hematoma led the patients to complete recovery;otherwise some serious complications such as paralysis of legs,urinary and fecal incontinence would happen. Conclusion:Thorough hemostasia and correct drainage in the operation, close observation following operation and surgical exploration in time are the basic measures that prevent the occurrence of the spinal epidural hematoma and effectively treat it.