脊柱手术后症状性脊柱硬脊膜外血肿的原因与对策

目的：探讨脊柱手术后症状性脊柱硬脊膜外血肿（SSEH）的发生原因及其对策。方法：回顾性分析脊柱手术后发生SSEH7例（病例组），选择同一期间、同一医生完成的术后未发生SSEH30例作为对照组，2组术后均使用低分子肝素，术后发生SSEH7例，其中有3例联用低分子肝素和低分子右旋糖酐，5例发生于引流管拔除前。比较2组的年龄、手术节段数、术中失血量及血肿清除前后神经功能评分，分析神经功能恢复与血肿压迫时间及血肿清除前神经功能的关系。结果：2组年龄及手术节段数差异均无统计学意义（P〉0．05），病例组术中失血量明显多于对照组（P〈0．01）。神经功能完全恢复与不完全恢复患者血肿压迫时间和血肿清除前感觉评分差异均无统计学意义（P〉0．05），而神经功能完全恢复患者运动评分高于不完全恢复患者（P〈0．05）。结论：使用抗凝药物不当、术中失血量大、引流不畅是术后硬脊膜外血肿的危险因素。术后硬脊膜外血肿一旦发生，应尽快处理，解除神经压迫。

Causes and curative strategy of symptomatic spinal epidural hematoma after spine surgery

Objective：To study the causes and curative strategy of symptomatic spinal epidural hematoma（SSEH） after spine surgery. Methods：Seven patients suffering from SSEH after spine surgery were included in the study, and 30 patients with no SSEH after spine surgery by the same surgeon in the same period acted as control. Both groups were administrated low-molecular-weight-heparin after operation. Seven cases developed SSEH after the surgery and three of them were administered dextran-40 combined with low-molecular- weight-heparin;5 cases developed SSEH before the drainage tubes were removed. The age of the patients, number of the operated segments and blood loss during the operation were compared between the two groups. The nervous function score and the recovery rate were compared between the two groups to find out the association of the recovery outcome with the duration of hematoma and the nervous function before the hematoma was cleared. Results： The patients＇ age and number of the operated segments were not statistically different between the two groups（ P 〉 0.05 ）, and there was more blood loss in the case group（ P 〈 0.01 ）. The duration of symptom and the American Spinal Injury Association SIA sensory score before hematoma evacuation were not statistically different between the patients with complete recovery of the neurological function and those with incomplete recovery （ P 〉 0.05 ） ; but the American Spinal Injury Association motor score of patients with complete recovery was higher than that of patients with incomplete recovery（P 〈 0.05）. Conclusions ：Improper use of anticoagulant, blood loss during operation and inadequate drainage are the risk factors for SSEH after spine surgery. Once SSEH occurs, hematoma evacuation should be immediately conducted to decompress the nerves.