氟骨病胸椎管狭窄症手术后血肿形成的早期诊断和治疗

目的分析氟骨病胸椎管狭窄症手术后伤口血肿形成的原因,总结早期诊断和治疗的方法。方法采用后路全椎板减压术治疗312例氟骨病胸椎管狭窄症患者,术后短期内出现神经症状恶化并经MRI检查证实为血肿形成18例,一经确诊马上实施血肿清除术。结果所有病例二次手术后神经症状均获得不同程度的恢复,得到早期诊断、早期治疗的病例恢复效果明显优于延迟治疗的病例。结论手术后血肿形成是氟骨病胸椎管狭窄症治疗中的一种严重并发症,只有早期诊断、及时手术清除才能获得满意的效果。     

Extensive postoperative epidural hematoma after full anticoagulation: case report and review of the literature

BACKGROUND/OBJECTIVE: A 67-year-old man with degenerative lumbar spinal stenosis and a medical history significant for coronary artery disease underwent routine lumbar surgical decompression. The objective of this study was to report a case of postoperative epidural hematoma associated with the use of emergent anticoagulation, including the dangers associated with spinal decompression and early postoperative anticoagulation. METHODS: Case report. FINDINGS: After anticoagulation therapy for postoperative myocardial ischemia, the patient developed paresis with ascending abdominal paraesthesias. Immediate decompression of the surgical wound was carried out at the bedside. Magnetic resonance imaging revealed a massive spinal epidural hematoma extending from the middle of the cervical spine to the sacrum. Emergent cervical, thoracic, and revision lumbar laminectomy without fusion was performed to decompress the spinal canal and evacuate the hematoma. RESULTS: Motor and sensory function returned to normal by 14 days postoperatively, but bowel and bladder function continued to be impaired. Postoperative radiographs showed that coronal and sagittal spinal alignment did not change significantly after extensive laminectomy. CONCLUSIONS: Full anticoagulation should be avoided in the early postoperative period. In cases requiring early vigorous anticoagulation, patients should be closely monitored for changes in neurologic status. Combined cervical, thoracic, and lumbar laminectomy, without instrumentation or fusion, is an acceptable treatment option.     

肾结石ESWL后肾脏血肿的原因分析

目的:探讨肾结石ESWL后肾脏血肿的原因。方法:对2008年5月~2012年6月5例肾结石ESWL后肾脏血肿的临床资料进行分析并文献复习。结果:采用上海交通大学JDPN-ⅤB型液电式碎石机治疗后引起肾脏血肿3例,深圳惠康HK.ESWL-109型电磁式碎石机治疗引起2例。体型肥胖并高血压2例(其中1例糖尿病)。2例因输尿管结石梗阻感染行输尿管镜取石术后行同侧肾结石ESWL后出现肾脏血肿,2例行一侧输尿管结石ESWL后行对侧肾结石ESWL后出现肾脏血肿,1例右输尿管上段结石ESWL后部分结石上移肾内行肾结石ESWL后出现肾脏血肿。4例保守治疗痊愈(肾包膜下血肿2例,肾包膜破裂肾周血肿2例);1例肾周大血肿腹膜后扩散,输血3 500ml,行高选择性肾动脉分支栓塞治愈。结论:ESWL并非绝对安全、没有重大并发症,只有掌握合适的适应证才安全可靠,在治疗前后需要仔细观察和评估。导致肾脏血肿的易患因素有凝血功能异常、抗凝药物的使用、糖尿病、高血压、老年患者、心脏病、肥胖等因素。高低能量冲击波的交替使用,有助于提高碎石的成功率及安全性。绝大多数患者可以通过保守治疗治愈,少数需要肾动脉栓塞治疗,个别严重患者需要肾切除来挽救生命。     

不同种类他汀药物对慢性硬膜下血肿治疗的临床效果

目的探讨不同种类他汀药物对慢性硬膜下血肿治疗的临床效果。方法选择2015年12月～2017年12月本院收治的慢性硬膜下血肿患者120例,按照使用他汀类药物不同分为三组,均为40例。所有患者均行对症支持处理,A组使用辛伐他汀(40 mg/d,晚间顿服),B组使用匹伐他汀(口服,每次1 mg,每天1次),C组使用阿托伐他汀(40 mg/d),比较各组患者的临床治疗效果,比较各组慢性硬膜下血肿治疗效果及各组硬膜下血肿吸收时间。结果 C组总有效率显著高于A组和B组(P0.05),C组硬膜下血肿吸收时间为(25.1±0.3)d;B组硬膜下血肿吸收时间为(38.2±1.6)d,A组硬膜下血肿吸收时间为(41.2±1.8)d;C组硬膜下血肿吸收时间优于A组和B组(t=19.814,P=0.0000.05)。结论针对慢性硬膜下血肿使用40 mg/d的阿托伐他汀治疗,能更好地提高患者临床治疗效果,促进神经功能恢复,值得推广。     

多维度延续性护理模式对慢性硬膜下血肿患者术后生活质量及护理工作满意度的影响

【摘要】 目的 观察多维度延续性护理模式对慢性硬膜下血肿（CSDH）患者术后的影响。方法 选取我院2019年2月至2021年2月85例CSDH患者为研究对象,按照入院顺序编号分组,对照组42例采取常规院外护理,观察组43例采取多维度延续性护理模式。比较2组患者干预期间并发症发生率及再入院率、干预结束后的护理依从性及护理工作满意度、干预前后的生活质量。结果 观察组并发症发生率4.65%（2/43）、再入院率6.98%（3/43）低于对照组21.43%（9/42）、26.19%（11/42）（P＜0.05）;观察组护理依从率高于对照组（P＜0.05）;干预后观察组活动能力、家庭及朋友支持、健康感觉、日常生活、对生活的认识评分高于对照组（P＜0.05）;观察组护理工作满意度93.02%（40/43）高于对照组73.81%（31/42）（P＜0.05）。结论 CSDH患者采用多维度延续性护理干预,不仅能降低并发症发生率及再入院率,改善患者护理依从性,还能提升患者的生活质量和护理满意度。     

The Comarr Memorial Award for Distinguished Clinical Service: The Legacy of A. Estin Comarr,MD

Abstract

Background

Subfascial wound suction drains are commonly used after spinal surgery to decrease the incidence of post-operative hematoma. However, there is a paucity of literature regarding their effectiveness.

Objective

To report four cases of post-operative spinal epidural hematoma causing massive neurological deficit in patients who had subfascial suction wound drains.

Methods

During an 8-year period, a retrospective review of 1750 consecutive adult spinal surgery cases was performed to determine the incidence, commonalities, and outcomes of catastrophic neurological deficit caused by post-operative spinal epidural hematoma.

Findings

Epidural hematoma causing major neurological deficit (American Spinal Injury Association B) was identified in 4 out of 1750 patients (0.23%). All four patients in this series had subfascial wound suction drains placed prophylactically at the conclusion of their initial procedure.

Results

Three patients developed massive neurological deficits with the drain in place; one patient had the drain removed at 24 hours and subsequently developed neurological symptoms during the following post-operative day. Significant risk factors for the development of hematoma were identified in two of the four patients. Average time to return to the operating room for hematoma evacuation was 6 hours (range 3–12 hours). Neurological status significantly improved in all four patients after hematoma evacuation.

Conclusions

Post-operative epidural hematoma causing catastrophic neurological deficit is a rare complication after spinal surgery. The presence of suction wound drains does not appear to prevent the occurrence of this devastating complication.     

硬膜外血肿并天幕疝的CT研究

目的 分析硬膜外血肿并天幕疝的CT表现，探讨血肿体积与天幕疝程度的关系。资料与方法 对86例硬膜外血肿患者应用斜坡垂线扫描法进行研究。结果 斜坡垂线扫描图像上，36例显示天幕疝，其CT表现为：与颞叶脑组织相连的小脑幕内侧环池内软组织密度影。颞叶疝至幕下3mm以内者4例，3－6mm者12例，6mm以上者20例，相应血肿体积分别为30.99-34.81ml、32.84-41.76ml和39．15－69．54ml。结论 应用斜坡垂线扫描法，CT可对硬膜外血肿合并天幕疝作出准确诊断；血肿体积与疝入程度有关。     

大鼠脑出血后血肿周围组织中树突状细胞的免疫功能研究

目的观察实验性大鼠脑血肿周围组织树突状细胞(dendritic cells,DC)的分布情况,进一步分析脑出血后不同时相内,DC在局部中枢性神经组织中免疫功能的作用。方法制作实验性大鼠基底节区脑血肿模型,分别检测24h、48h、72h、5d和7d各时相点神经功能障碍、脑组织水肿情况及局部脑组织中IL-6和GM-CSF的浓度、阳性DC数量。结果出血组GM-CSF浓度在48h时增加,随后仍保持持续性上升。实验组IL-6浓度在术后48h达到高峰,随后下降;实验组DC在术后24h时观察到,并随时间的延长持续增加。结论实验大鼠脑出血周围组织中的微状态变化,将限制和影响DC在不同时相的作用。在脑出血前期促进脑组织损害,脑出血后期有利于局部脑组织修复。     

Significance of haemorrhagic lacunes on MRI in patients with hypertensive cerebrovascular disease and intracerebral haemorrhage

Our purpose was to determine the frequency and signifcance of haemorrhagic lacunes (HL) on MRI in patients with a history of, or at risk for intracerebral haemorrhage. We examined 72 patients with old spontaneous intracerebral haemorrhage (ICH) using T1-and T2-weighted spin-echo sequences. MRI studies of 137 consecutive patients with cerebrovascular disease but no known ICH were also reviewed. Both groups showed about the same degree of age-related white matter change and nonhaemorrhagic lacunar infarcts, whereas the ICH group had a higher frequency of HL (12/72 patients) than the non-ICH group (6/131 patients,p<0.01). These results correlate well with reported pathological findings. We conclude that haemorrhagic lacunes found on MRI studies of patients with cerebrovascular disease may suggest a higher risk of intracerebral haemorrhage.     

脑血肿动物模型的建立及MRI表现

本文详细介绍了脑血肿动物模型的建立方法，其成功的关键是，选择适当的钻孔点和注入的深度及血肿量，此外掌握好注入的速度也很重要，同时了各期龄脑血肿模型的ＭＲＩ表现，还有血肿模型的价值评价。