自发性椎管内硬膜外、硬膜下血肿的诊断和治疗

Spontaneous spinal epidural and subdural hematoma: diagnostic and therapeutic aspects

目的 探讨比较自发性硬脊膜外、硬膜下血肿的出血原因、临床表现、影像特征及治疗预后。方法 结合相关文献 ,回顾性分析 7例自发性硬脊膜外血肿和 1例自发性硬膜下血肿的流行病学、发病机制、部位、临床特征、神经功能状态 ,以及手术、保守治疗和预后。结果 有 6例患者手术治疗 ,1例痊愈 ,2例保守治疗 ,1例痊愈。结论 自发性硬脊膜外、硬膜下血肿多急性起病 ,硬脊膜外较硬膜下血肿更为常见 ,且MRI显示椎管内占位影较CT明显。MRI检查是诊断本病最佳方法。手术减压是改善预后的主要方法。起病到治疗的时间间隔越短预后越好。

Objective To evaluate the characteristics of spinal epidural and subdural haematomas in clinical situation and MRI diagnosis and therapeutic outcome.Methods 8 patients with neurological deficits and without a history of severe trauma were studied.In all cases followed by MRI studies before and after administration of contrast agent.2 patients also followed by CT.6 patients underwent open surgery.Two patients underwent non-operative treatments.Two patients recovered completely.Results The hematomas had an epidural location in seven cases(2 cases in the cervical spine,4 cases in the thoracic region and 1 in the lumbar region,and a subdural 1 in the cervical spine).Epidural hematomas were much more common than subdural ones.Subdural blood collections were mainly found ventral to the spinal cord.Epidural hematomas were always located dorsal to the spinal cord.Spontaneous spinal hematomas were frequently located in the thoracic spine.Subdural spinal hematomas were more frequent than epidural.Epidural hematomas were frequently located dorsal to the spinal cord.Conclusion The diagnosis of spontaneous spinal haematomas mainly depends on magnetic resonance imaging.MRI is superior to CT for diagnosis.Open surgical treatment may lead to complete recovery of the neurological deficit.Interval of onset and treatment is shorter,the recovery is better.