创伤性椎管内硬膜外血肿病人的监护

椎管内硬膜外血肿临床少见 ,特别是医源性椎管内硬膜外血肿 ,更为少见。我院自 1988年至 2 0 0 0年共收治经手术证实的椎管内硬膜外血肿 3例 ,本组资料表明准确的病情观察对早期诊断和及时手术治疗起到非常重要作用 ,现报告如下。临床资料例 1:男 ,5 3岁。因急性坏死性胰腺炎行 T9～ 10 间隙硬膜外麻醉穿刺术 ,手术后 36 h出现胸背部疼痛 ,腹股沟以下皮肤感觉减退 ,双下肢肌力 级 ,肌张力增高 ,尿潴留。病理反射阴性。 CT提示 T8～ 11椎管内硬膜外血肿 ,脊髓压迫。即行椎管探查血肿清除术。见 T8～ 11节段椎管内血肿。术后随访 1年 ,患者…     

自发性椎管内硬膜外血肿1例报道

<正>自发性椎管内硬膜外血肿病例,临床上较为少见,发病早期诊断较困难。2014-11-25我科室遇到1例,现报道如下。1临床资料患者男,65岁,于2014-11-25夜间过夫妻生活时突然出现腰痛,呈持续性胀痛,疼痛放射至臀部及左下肢,伴双下肢麻木,左侧为甚,坐位、站立及弯腰加重,平卧休息症状稍缓解,无     

急性自发性椎管内硬膜外血肿的诊治

目的：探讨急性自发性椎管内硬膜外血肿的手术时机与治疗效果的关系。方法：比较不同时机手术的2例病人的临床疗效。结果：早期椎板切除减压手术治疗，临床效果满意。而延误手术时机，则难山恢复，结论：手术时机的早晚，直接决定该病的治疗效果。     

自发性椎管内硬膜外血肿5例的诊疗体会

[目的]探讨自发性椎管内硬膜外血肿的临床表现及诊治过程。[方法]回顾性调查2014年9月～2017年4月共5例诊断为自发性椎管内硬膜外血肿在本院脊柱骨科住院治疗的患者。记录患者的流行病学资料、临床特征、实验室检查、影像学表现及治疗方法,评价治疗效果与预后。[结果] 5例患者中男性2例,女性3例,平均年龄(69.82±10.74)岁,自发性血肿发生的部位:颈段1例,胸段以及胸腰段4例。ASIA分级:3例A级,1例C级,1例D级。按血肿MRI分期:超急性期1例,亚急性早期1例,亚急性晚期3例。3例行椎板减压血肿清除术,2例行保守治疗。所有患者经至少1年以上随访。末次随访时ASIA评分:A级1例,B级1例,E级3例。[结论]自发性椎管内硬膜外血肿应及早做出诊断和治疗,防止延误治疗的最佳时机。     

自发性椎管硬膜内血肿

目的：探讨自发性椎管硬膜内血肿(SSDH)的临床特点及治疗。方法：2例患者，均为女性，年龄分别为65、58岁；均以突发性腰痛伴有双下肢疼痛、无力就诊，MRI示分别于脊柱腰段及胸腰段椎管硬膜内血肿。明确诊断后均于以手术治疗，行血肿清除术。结果：术后2例患者症状、体征均明显改善；经过6个月～1年的随访，2例患者完全康复．结论：自发性椎管硬膜内血肿发病急，症状重；MRI是确诊最可靠的手段；有脊髓压迫症状的患者，需要急诊手术。     

急性自发性椎管内硬膜外血肿的临床特征及治疗

目的:总结急性自发性椎管内硬膜外血肿(acute spontaneous spinal epidural hematoma,ASSEH)的临床和影像学特征,探讨其治疗方法及预后.方法:收集我院2005年1月～2020年12月收治的27例ASSEH患者的临床和影像学资料,回顾性分析病因、临床表现、影像学特征、治疗过程、手...     

胸椎管内硬膜外自发性血肿—例

笔者于2010年1月收治1例胸椎椎管内硬膜外自发性血肿。现报告如下。     

慢性自发性腰椎管内硬膜外血肿1例

正患者,男,77岁,因"腰痛伴双下肢麻木、疼痛、无力8年,加重2个月"于2016年11月7日入院。患者8年前腰痛,伴双下肢麻木、无力,间歇性跛行,2个月前无明显诱因出现腰痛明显加重伴双侧臀部疼痛,站立行走时疼痛明显,并伴尿频、尿急。查体:腰背部压痛、叩痛明显,伴双侧臀部放射痛,腰椎屈伸活动受限明显,右小腿及足部针刺觉减弱,双侧胫前肌肌力Ⅳ级,双拇趾背伸肌力Ⅲ级,双足跖屈肌力     

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 feature and surgical treatment of spontaneous spinal epidural hematoma

We presented 10 patients of spontaneous spinal epidural hematoma (SSEH) who were surgically treated between July 1996 and June 2003. One male and 9 female patients whose ages ranged from 16 to 75 years (mean age is 60) enrolled in this study. All cases initially presented with severe back and radicular pain followed by sensory and motor dysfunction. Sphincter dysfunction was observed in 8 patients. Although three cases were initially suspected as cardiovascular diseases and two as cerebral stroke, all cases were successfully diagnosed with magnetic resonance imaging studies. The hematoma was located at the dorsal cervical levels in 3 cases, the dorsal cervicothoracic in 1, the dorsal thoracic in 4, the ventral thoracic in 1, and the ventral lumbosacral in 1. After surgical evacuation of the hematoma, neurological dysfunctions improved in all patients. In particular, surgical decompression was performed within 36 hours after onset in 5 cases suffering severe neurological dysfunction according to the Frankel Grading System. To obtain good prognosis for patients with SSEH, early diagnosis and immediate treatment are important.     

Four cases of spontaneous spinal epidural hematoma

Spontaneous spinal epidural hematoma (SSEH) is a rare clinical entity. Although approximately 500 cases have been reported, controversy exists concerning timing of the treatment and the validity of decompression surgery. We recently encountered four cases of SSEH. Evacuation of the hematoma was carried out in two patients with severe or persistent neurological deficits. Other two patients were treated conservatively because of the rapid resolution of the symptoms. All four patients improved after the treatment; three patients fully recovered and one patient required rehabilitation for moderate quadriparesis. Many previous reports recommended decompression surgery within 48 hours after the onset, however, one patient in our series fully recovered after surgery 4 days after the onset. We reviewed 183 operative cases of SSEH with incomplete neurological deficits in the literature and found that 93% of the patients who underwent surgery more than 48 hours after symptom onset showed good neurological recovery. Conservative treatment should be undertaken for rapidly improving patients, but surgical intervention should be considered in symptomatic patients regardless of the time from the onset.     

Surgical management of spontaneous spinal epidural hematoma

Spontaneous spinal epidural hematoma (SSEH) is a rare disease entity; its causative factors and the factors determining the outcome are still controversial. We reviewed our clinical experiences and analyzed the various factors related to the outcome for SSEH. We investigated 14 patients (11 men and 3 women) who underwent hematoma removal for SSEH from April 1998 to August 2004. We reviewed age, gender, hypertension, anticoagulant use and the preoperative neurological status using the Japanese Orthopaedics Association score by examining medical records, operative records, pathology reports, and radiographies, retrospectively. We were checking for factors such as the degree of cord compression owing to hematoma and the extent and location of the hematoma. Most patients included in the study were in their twenties or fifties. Four hematoma were located in the cervical region (29%), three were cervicothoracic (21%), four were thoracic (29%) and three were in the lumbar (21%) region and also 12 were located at the dorsal aspect of the spinal cord. In all cases, the neurological outcome improved after the surgical operation. There was a statistically significant difference between the incomplete and complete neurological injury for the preoperative status (P<0.05). The neurological outcome was good in those cases that had their hematoma removed within 24 h (P<0.05). The patients with incomplete neurological injury who had a surgical operation performed within 12 h had an excellent surgical outcome (P<0.01). Spontaneous spinal epidural hematoma was favorably treated by the means of a surgical operation. The favorable factors for SSEH operations were incomplete neurological injury at the time of the preoperative status and the short operative time interval.     

自发性硬脊膜外血肿的诊断与治疗

目的 探讨自发性硬脊膜外血肿的出血原因、临床表现、MRI特征、治疗及预后相关因素。方法 结合相关文献,回顾性分析6例自发性硬脊膜外血肿（SSEH）的发病机制、临床特征、术前神经功能状态及发病到手术的时间间隔与预后因素。结果 SSEH好发于年轻患者,多急性起病。MRI显示椎管后方或后外方半月形占位影。患者预后与术前神经功能状态及发病到手术的时间间隔密切相关,与年龄、血肿部位、血肿大小无关。患者术前的神经功能状态越好预后越佳,发病到手术的时间间隔越短预后越好。结论 MRI检查是诊断本病最佳方法。及时的脊髓减压手术是改善预后的关键。     

Clinical management for spontaneous spinal epidural hematoma: diagnosis and treatment.

BACKGROUND CONTEXT: Spontaneous spinal epidural hematoma (SSEH) is a very rare condition, so there were few studies assessing the management criteria of SSEH. PURPOSE: To assess the differential diagnosis and clinical results of treatment for SSEH. STUDY DESIGN: A retrospective chart and radiograph review of the patients with SSEH. PATIENT SAMPLE: Seven consecutive patients with SSEH who were treated in our institute. OUTCOME MEASURES: Differential diagnosis, severity of the paresis, and treatment selection were assessed preoperatively and postoperatively. METHODS: We assessed the relationship between the following parameters and clinical results: (1) the initial symptoms, (2) imaging diagnosis of magnetic resonance imaging (MRI), (3) treatment selection (conservative or surgical treatment), (4) the interval of surgery, and (5) the severity of paresis using ASIA impairment scale (AIS) grading. RESULTS: In all patients, the symptoms at onset were severe neck and back pain. MRI showed isointensity to the spinal cord in the T1-weighted view and iso- or high intensity in the T2-weighted view. A solid pattern in MRI was shown in 4 patients, and a mosaic pattern was shown in 3 patients. Decompression was performed in five cases, and spontaneous recovery appeared in two cases. The mean interval time for operation was 29.8 hours. The severity of paresis was grade B in 3 cases and grade C in 4 cases at onset. These cases recovered to become grade E in 3 cases and grade D in 4 cases. Neurological deficits were present in two patients with conservative therapy and in two patients with a long interval for operation. CONCLUSIONS: Precise diagnosis without delay and rapid surgical treatment are essential for the management of SSEH.     

Cervical spinal epidural hematoma with spontaneous remission.

Spinal epidural hematoma (SEH) is comparatively rare. In most cases, urgent surgical decompression is necessary. Several reports have described spontaneous remission of SEH. The authors present a rare case of spontaneous resolution of cervical SEH.