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中华脑科疾病与康复杂志(电子版) ›› 2021, Vol. 11 ›› Issue (06) : 325 -330. doi: 10.3877/cma.j.issn.2095-123X.2021.06.002

临床研究

自发性硬脊膜外血肿急诊救治现状分析
王旋1, 项宇飞1, 周迎春1,()   
  1. 1. 430022 武汉,华中科技大学同济医学院附属协和医院神经外科
  • 收稿日期:2021-10-26 出版日期:2021-12-15
  • 通信作者: 周迎春

Analysis of emergency treatment of spontaneous epidural hematoma

Xuan Wang1, Yufei Xiang1, Yingchun Zhou1,()   

  1. 1. Department of Neurosurgery, Union Hospital Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, China
  • Received:2021-10-26 Published:2021-12-15
  • Corresponding author: Yingchun Zhou
引用本文:

王旋, 项宇飞, 周迎春. 自发性硬脊膜外血肿急诊救治现状分析[J/OL]. 中华脑科疾病与康复杂志(电子版), 2021, 11(06): 325-330.

Xuan Wang, Yufei Xiang, Yingchun Zhou. Analysis of emergency treatment of spontaneous epidural hematoma[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(06): 325-330.

目的

分析自发性硬脊膜外血肿(SSEH)急诊救治现状,提出改善现状的对策。

方法

回顾性分析华中科技大学同济医学院附属协和医院神经外科自2015年3月至2019年11月行手术治疗的18例SSEH患者,对其临床表现、诊断方式和流程、出现神经功能障碍到手术时间间隔及手术后神经功能恢复情况进行总结。

结果

18例患者均在发病后不同时间出现了神经功能障碍,首发症状:14例为剧烈疼痛,1例为颈部无力,3例为胸部以下截瘫。所有患者最终通过MRI检查确认椎管内出血,从神经功能障碍到MRI检查的时间为2~120 h,平均43.3 h。患者经手术治疗,15例(83.3%)治愈,2例(11.1%)好转,1例(5.6%)无效。患者出现神经功能障碍到手术的时间间隔越长,疗效越差,神经功能恢复过程越长。

结论

提高首诊医师对SSEH的认识,及时进行MRI检查,有助于早期确诊和早期手术,促进神经功能恢复,减少后遗症。

Objective

To analyze the emergency treatment for spontaneous spinal epidural hematoma (SSEH) and propose the countermeasures to improve the status quo.

Methods

Eighteen with SSEH who underwent surgery in the Department of Neurosurgery of Union Hospital Affiliated to Tongji Medical College of Huazhong University of science and technology from March 2015 to November 2019 were analyzed retrospectively, and their clinical features, diagnostic methods and procedures, the time interval from neurological dysfunction to surgery and the recovery of neurological function after surgery were summarized.

Results

All the 18 patients had neurological dysfunction at different time after the onset of the disease. The first symptoms were severe pain in 14 cases, neck weakness in 1 case and paraplegia below the chest in 3 cases. All patients finally confirmed intracerebral hemorrhage by MRI, and the time from neurological dysfunction to MRI was 2-120 h, with an average of 43.3 h. After surgical treatment, 15 cases (83.3%) were cured, 2 cases (11.1%) were improved and 1 case (5.6%) was invalid. The longer the time between the onset of neurological dysfunction and surgery, the worse the outcome and the longer the recovery process of neurological function.

Conclusion

Improving the understanding of SSEH among first-diagnosis physicians and timely conduct MRI examination is helpful to early diagnosis and early operation, promote the recovery of neurological function and reduce sequelae.

图1 患者肢体症状统计
表1 18例自发性硬脊膜外血肿手术患者临床资料
图2 硬脊膜外血肿症状及分布统计A:患者肢体症状统计图;B:发生节段统计图
图3 硬脊膜外血肿患者手术时间、预后影响统计分析A:神经功能恢复与发病后MRI检查间隔时间关系分布图;B:神经功能恢复时间与发病后手术间隔时间关系分布图;C:运动功能恢复时间与术前ASIA分级关系分布图;D:出血量和术前ASIA相似的患者MRI检查时间和手术时间间隔长短对神经功能恢复的影响
图4 自发性硬脊膜外血肿患者术前、术后MRI资料A~B:术前颈椎MRI平扫,可见颈胸段椎管内T1、T2像混杂信号影,脊髓严重受压并缺血,提示硬脊膜外亚急性血肿;C~D:术后9个月复查影像,见血肿清除,脊髓受压解除
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