自发性脊髓硬膜外和硬膜下血肿

Spontaneous spinal epidural hematom aand spontaneous spinal subdural hematoma:report of six cases

目的探讨自发性脊髓硬膜外血肿(SSEH)及硬膜下血肿(SSSH)的病因、临床特点、诊治方法及预后相关因素。方法自1995～2002年收治的4例SSEH及2例SSSH患者,均在静息或轻微活动后发病,发病前均无感染或服药史,其中1例63岁患者诉有高血压病史,1例65岁患者入院检查后发现患有Ⅱ型糖尿病,余均否认患有其他疾病。所有患者均表现为突发性的颈、肩、胸、背部疼痛,数分钟到数小时内出现肢体运动、感觉障碍、大小便障碍及潴留,5例患者有神经根放射痛症状。有3例行腰穿,压力无明显增高。均行手术治疗,手术距发病时间10～16d,平均12.5d,手术均在局麻下进行,4例SSEH患者行患部全椎板切除血肿清除术,2例SSSH患者行全椎板切除并硬脊膜切开血肿清除,硬脊膜修补术。结果均经MR检查、手术及病理证实。MRI显示椎管后方或后外方占位性病变,T1加权能特征性地反映血肿随时间发生的信号变化而最有价值,T2加权可很好地判断血肿的位置。患者预后与术前的神经功能状态及发病至手术的时间密切相关。本组患者随访6～18个月,平均10个月。6例患者除大、小便功能有不同程度的改善外,5例患者肢体的运动、感觉功能无明显恢复,1例SSSH患者感觉消失平面下降,右上肢肌力较前增强。结论自发性脊髓硬膜外及硬膜下血肿是一种少见病。

Objective To study the etiology,clinical presentation,MR images,treatment and prog-nosis of spontaneous spinal epidural and subdural hematoma.Methods From1995to2002,6cases diag-nosed as spontaneous spinal epidural and subdural hematoma were reviewed retrospectively.All of the pa-tients were males aging from30to68years with an average of 47years.The onset was acute while the pa-tients were in resting or light activity without prior history of any infection,administration of drugs or trau-ma.One patient had the history of hypertension,and another one was found to have diabetes after admission.The clinical characteristics were sudden pain involving neck,shoulder,chest and back,then dysfunction of motion and sensation of extremities and sphincter within few minutes.4cases of spontaneous spinal epidural hematoma were located at T 5~6 ,T 2~4 ,C 4~5 and C 6 ~T 1 respectively,and2cases of spontaneous spinal subdu ral hematoma at C 7 ~T 1 and C 7 ~T 2 respectively.Results All cases were proved with surgery and pathology.MR imaging showed occupying mass in the posterior or posteriolateral region inside the spinal canal.T 1 -weighted imaging was most useful owing to its typical signal changes with the hematoma.T 2 -weighted gra-dient echo sequence was capable to identify epidural and subdural spinal hematoma.Total laminectomy and hematoma debridement were performed.The outcome was closely related to the interval between the onset and surgery.The patients were followed up from6to18months with an average of 10months.All cases showed no significant improvement of spinal cord function except 5cases with incomplete recovery of sphincter function.Conclusion Spontaneous spinal epidural and subdural hematoma are rare entities.MRI is a most helpful diagnostic tool for this disorder.It should be stressed that early diagnosis and prompt surgical intervention are of great importance for prognosis of spontaneous spinal epidural hematoma.