自发性硬脊膜外血肿的诊断和治疗策略

目的探讨自发性硬脊膜外血肿的临床特征、治疗及影响预后的因素。方法对16例自发性硬脊膜外血肿患者的临床特征、手术治疗时机以及手术后神经功能恢复情况进行回顾总结,并结合文献分析影响预后的因素。所有自发性硬脊膜外血肿患者均行MRI检查。结果16例患者的硬脊膜外血肿分别位于下颈段（2例）、颈胸段（6例）、胸段（7例）及胸腰段（1例）。MRI检查T1WI表现为等信号或略高信号,T2WI以高信号为主,其中可见混杂低信号。12例施行手术治疗的患者中10例预后良好;4例保守治疗者中3例神经功能完全恢复。结论脊髓MRI检查是诊断自发性硬脊膜外血肿的首选方法,早期诊断和外科手术治疗是恢复神经功能、提高疗效的关键。手术疗效主要与自发性硬脊膜外血肿患者手术前的神经功能缺损程度和手术间隔时间有关;症状较轻者在密切观察下可予以保守治疗,其神经功能的恢复主要取决于神经功能缺损程度。目的探讨自发性硬脊膜外血肿的临床特征、治疗及影响预后的因素。方法对16例自发性硬脊膜外血肿患者的临床特征、手术治疗时机以及手术后神经功能恢复情况进行回顾总结,并结合文献分析影响预后的因素。所有自发性硬脊膜外血肿患者均行MRI检查。结果16例患者的硬脊膜外血肿分别位于下颈段（2例）、颈胸段（6例）、胸段（7例）及胸腰段（1例）。MRI检查T1WI表现为等信号或略高信号,T2WI以高信号为主,其中可见混杂低信号。12例施行手术治疗的患者中10例预后良好;4例保守治疗者中3例神经功能完全恢复。结论脊髓MRI检查是诊断自发性硬脊膜外血肿的首选方法,早期诊断和外科手术治疗是恢复神经功能、提高疗效的关键。手术疗效主要与自发性硬脊膜外血肿患者手术前的神经功能缺损程度和手术间隔时间有关;症状较轻者在密切观察下可予以保守治疗,其神经功能的恢复主要取决于神经功能缺损程度。

Diagnosis and treatment of spontaneous spinal epidural hematoma

Objective To investigate the clinical feature, treatment and factors affecting the prognosis of spontaneous spinal epidural hematoma (SSEH). Methods Analyzed retrospectively the clinical feature, timing of surgical treatment and recovery of neurological function after surgical treatment in 16 patients with SSEH. Evaluated the factors affecting the outcome based on our material and literatures. All the patients with SSEH underwent MR imaging examination. Results The SSEH were located in the lower cervical (n = 2), cervicothoracic (n = 6), thoracic (n = 7), and thoracolumbar (n = 1) regions. On T1WI, the singal intensity of SSEH was isointense or slightly hyperintense to the spine cord. On T2WI, SSEH presented hyperintense predominately with focal heterogeneous hypointensity. Neurological outcome was improved in 10 of 12 patients (10/12, 83.33%) treated with surgical management; and neurological function was recovered in 3 of 4 cases (3/4, 75.00%) treated with conservative therapy. Conclusion MRI is the first choice in the diagnosis of spontaneous spinal epidural hematoma. Early diagnosis and surgical treatment of spontaneous spinal epidural hematoma is the key to neurological function recovery and satisfactory result. The efficacy of spontaneous spinal epidural hematoma operation are mainly related to preoperative deficiency intensity of neurological function and operative time interval. The conservative treatment with close observation may be performed in cases with minimal neurologic deficits, and the injury status determines neurological function recovery.