自发性椎管内硬膜外血肿的影像学及临床特征

目的分析自发性椎管内硬膜外血肿(SSEH)的影像学特征及临床治疗效果。方法回顾性分析2008年6月—2018年9月泰州市人民医院脊柱外科收治的SSEH患者临床资料,分析其影像学表现。采用硬膜外脊髓压迫(ESCC)分级评估硬膜外占位对硬膜囊及脊髓的压迫程度,美国脊髓损伤协会(ASIA)分级评估神经功能,疼痛视觉模拟量表(VAS)评分评估疼痛情况。结果本研究共纳入12例患者,年龄25 ～ 74岁,中位年龄64.5岁。MRI显示SSEH大多呈梭形、椭圆形,且多位于脊髓侧后方或后方的硬膜外腔。血肿最多发于颈段(4例)或颈胸段(4例)。血肿累及1 ～ 4个节段,平均2.6个节段。T1WI MRI上7例表现为等信号,4例表现为高信号,1例表现为低信号;T2WI MRI上10例表现为高/混杂信号,2例表现为低信号。血肿压迫脊髓程度(ESCC分级)与患者神经功能损伤程度(AISA分级)密切相关(r=0.85,P 0.01)。7例患者行手术治疗,其中5例术后神经功能有所恢复,2例术前ASIA分级为A级的患者末次随访时仍为A级;5例采用非手术治疗,治疗后神经功能均有所恢复,VAS评分下降。结论 MRI是诊断SSEH的最佳检查方法。根据患者神经功能损伤及进展情形,可选择非手术治疗或尽早手术治疗。

Clinical and radiological characteristics of spontaneous spinal epidural hematoma

Objective To evaluate radiological characteristics of spontaneous spinal epidural hematoma(SSEH) and assess the clinical outcome. Methods The patients with SSEH treated in Taizhou People''s Hospital from June 2008 to September 2018 were analyzed retrospectively. The degree of compression of epidural space occupying on the dural sac and spinal cord was assessed by epidural spinal cord compression(ESCC) grade,the neurological function by American Spinal Injury Association(ASIA) grade,and the pain by visual analogue scale(VAS) score. Results Twelve patients were included in the study. The median age was 64.5 years(range,25-74 years).Most hematomas were spindle or ellipse shaped and located at the dorsal or posterolateral epidural space. The cervical region(4 cases) and cervicothoracic junction(4 cases) were most commonly affected,and the average haematoma size extended across 2.6 vertebral levels(range,1-4 segments). On T1WI MRI,the hematoma was isointense in 7 cases,slightly hyperintense in 4 and hypointense in 1 compared with the cord. On T1WI MRI,10 cases were hyperintense/heterogeneous,2 hypointense compared with the cord. The degree of hematoma compression of the spinal cord(ESCC grade) was closely related to the degree of neurological impairment(ASIA grade) in the patients(r=0.85,P<0.01). Seven patients received surgical treatment,5 of them recovered in neurological function,the remaining 2 with grade A before treatment were still grade A at the final follow-up. Five received conservative treatment,their neurological function recovered and VAS score decreased. Conclusion MRI is the preferred diagnostic tool for SSEH. For the management of SSEH,conservative treatment or early surgical treatment can be selected according to neurological status and its evolvement.