腰椎后路减压内固定术后硬膜外血肿形成的原因及诊治.pdfVIP

·414 · 临床骨科杂志　 Journal of Clinical Orthopaedics　 2015 Aug;18(4) doi:10.3969/ j.issn.1008-0287.2015.04.009 ·临床论著 · 腰椎后路减压内固定术后硬膜外血肿形成的原因及诊 治 洪加源,刘　 强,黄丽萍,武　 宁,敖庆芳,龚星星 摘要:目的　 探讨腰椎减压内固定术后硬膜外血肿形成的原因、诊治及预防对策。 方法　 2089例接受腰椎后 路减压内固定手术的患者中,术后发生硬膜外血肿7例,均行急诊手术探查并清除血肿;分析其硬膜外血肿形 成的原因,探讨预防对策。 结果　 7例术后硬膜外血肿患者的首发症状均为神经功能减退,其中6例表现出 下肢神经症状进行性加重,1例小便障碍。 5例术后24 h 内行椎管探查术,2例24 ~48 h 内行椎管探查术。 4 例术前经MRI确诊有硬膜外血肿,3例未行MRI检查。 术后随访1年,手术探查清除血肿越早患者神经功能 恢复越好。 结论　 硬膜外血肿的形成与多节段减压、止血材料使用不当、使用抗凝剂及止血不彻底等因素有 关,术后密切观察病情、早期MRI确诊和及时的椎管探查手术,是预防和治疗术后硬膜外血肿的主要方法。 关键词:腰椎减压;内固定术;硬膜外血肿 中图分类号:R687.3;R681.53　 文献标识码:A　 文章编号:1008-0287(2015)04-0414-04 Analysis and prevention of spinal epidural hematoma following lumbar spine decompression and internal fixation　 HONGJia-yuan,LIU Qiang,HUANGLi-ping,WUNing,AO Qing-fang, GONGXing-xing　 (Orthopaedic Centerof PLA,the175thHospitalof PLA,DongnanHospitalAffili- ated toXiamen University,Zhangzhou,Fujian　 363000,China) Abstract:Objective　 To investigate the reason,discuss its diagnosis,treatment and prevention of the spinal epidural hematoma (SEH)followingdecompressionandinternalfixationoflumbar spine. Methods　 2089 caseswithdecom- pression and internal fixation of lumbar spinewereenrolled. SevencaseshadSEHaftertheprimary surgery andwere treated by hematomaevacuationanddecompression. PreventivecountermeasuresoftheSEHwereassessed.Results　 Neurological deteriorationwastheinitial symptomin7 casesof SEH. Six casesshowedlowerlimbprogressiveandse- vere neurologic deficit,one case showed urine dysfunction. Surgical explorationwasperformedwhen primary surgery was performedwithin24 hin5 cases,between24 ~48hin2 cases. Fourcaseswereconfirmedby MRIbeforesurgi- cal exploration,three cases were not confirmed by MRI before surgical exploration. During the follow-up of 12 months,neurological functionrecoveryofthepatientwhohadsurgery explorationintimewasbetterthanthedelayed. Conclusions　 Thesefactors