颈椎管内自发性硬膜外血肿手术时机选择的初步研究

目的探讨颈椎管内急性自发性硬膜外血肿的手术治疗时机,评估神经损伤程度及手术时机对其预后的影响。方法回顾性分析2008年1月~2011年9月笔者所在医院收治的7例颈椎管内自发性硬膜外血肿患者的临床资料,通过日本骨科协会评分和改善指数,对影响预后的因素进行分析。结果从发病到手术的间隔时间是6～216h,术后没有出现新的并发症。不完全脊髓损伤组和完全性脊髓损伤组的术前与术后的改善率均存在差异(P<0.05);术后5个月随访时,不完全损伤组的脊髓功能恢复率明显好于完全损伤组(P<0.05)。此外,12h以内手术的患者,其术后功能改善率大于12h手术的患者,分别为(80.8±24.5)%和(44.4±35.6)%。结论颈椎管内自发性硬膜外血肿的预后可能与患者当初的神经损伤程度有关,术前脊髓损伤越严重,术后功能恢复越差;反之,神经功能恢复越好。对于不完全性神经损伤,且出现进行性恶化的患者,应在12h内完成脊髓减压术,可能获得更好的预后效果;对于完全性神经损伤的患者,应尽量在24h内完成手术。

Preliminary research on operation timing of acute spontaneous cervical epidural hematomas

Objective To discuss sugical timing of acute spontaneous cervical epidural hematomas,and evaluate the ralationship between sugical timing and nerological outcome. Methods From August 2000 to October 2003,we retrospectively reviewed 7 consecutive patients with acute spontaneous cervical epidural hematomas who underwent sugical management.We evaluated progonostic factors by comparing pro- and post-operative JOA scores. Results There was no complication related to the surgical operations.There was a statistically significant difference between the incomplete and complete neurological injury for the preoperative status after 5 months after operation (P < 0.05). The patients with neurological injury who had a surgical operation performed within 12 h had an excellent surgical outcome than without 12 h. Conclusion The preoperative neurological status was an important factor that decided neurological recovery. In addition,the incomplete injury patients underwent decompression in the 12 h;the complete injury patients underwent operative treatment in the 24 h.