自发性硬脊膜外出血12例临床分析

【摘要】目的探讨自发性硬脊膜外出血(SSEH)的发病因素、诊断、治疗方法及预后。方法回顾性分析12例SSEH患者的临床资料。采用美国脊髓损伤协会神经功能评定标准（ASIA分级）对患者的病情及预后进行评估。9例患者（4例A级、2例B级、2例C级、1例D级）采用手术治疗，3例患者（D级）采用保守治疗。结果本组患者中7例患者有不同程度改善。9例手术患者均采用椎管扩大减压并清除血肿的手术方式，4例患者进一步行硬脊膜下减压；6例患者术后得到改善，其中3例患者痊愈。3例保守治疗患者中仅1例患者痊愈。结论SSEH的病因复杂，血肿来源于硬脊膜外静脉。早期结合患者的症状体征和脊髓MRI检查的诊断至关重要；尽早进行显微减压（骨性＋硬脊膜下）手术是首选的治疗方案，脊柱稳定性的保护是需要考虑的问题。治疗前的临床状态及治疗的及时性和有效性是影响患者预后的主要因素。

Abstract： Objective To explore the pathogenesis, diagnosis, treatment and prognosis of spontaneous spinal epidural hematoma(SSEH). Methods The clinical data of 12 patients with SSEH were analyzed retrospectively. The American Spinal Injury Association Neurological Assessment Standard(ASIA classification) was used to evaluate the improvement of the patient’s condition and prognosis. Of 9 cases, 4 of grade A, 2 of grade B, 2 of grade C, and 1 of grade D were treated by surgery, and 3 of grade D were treated conservatively. Results A total of 7 patients had improved to various degrees. All surgical methods include spinal canal enlargement and decompression and removal of hematoma. 4 cases were further subjected to subdural decompression. The symptoms of 6 cases were improved, and 3 cases were healed. Only one of the conservatively treated patients recovered. Conclusions SSEH has complicated etiology, and originates from the internal vertebral venous plexus. Diagnosing the patient with symptoms and MRI at an early stage is significant. Microscopic decompression surgery(bone+subdural) is the preferred treatment option as soon as possible, and the protection of spine stability is a problem that needs to be considered. The clinical status before treatment, the timeliness and effectiveness of treatment are the main factors affecting the prognosis of patients.