Börm Wolfgang, Mohr Klaus, Hassepass Uwe, Richter Hans-Peter, Kast Erich
Neurosurgical Department, University of Ulm, Günzburg, Germany.
Spine (Phila Pa 1976). 2004 Dec 15;29(24):E555-61. doi: 10.1097/01.brs.0000147743.46315.8b.
Retrospective clinical study.
To determine characteristics, treatment methods, and outcome in an institutional series of patients with spinal hematoma not related to previous surgery.
The charts of all patients with spinal hematoma treated in our institution between January 1993 and December 2002 were reviewed and analyzed with regard to location and extension of the hematoma, duration of symptoms, neurologic status, diagnostic measures, therapy, and outcome.
Fifteen patients were identified with spinal hematomas not caused by previous spine surgery. There were 11 women and 4 men. One hematoma was located subdurally and another intramedullary. All other hematomas were extradural, with 10 spontaneous bleedings. Eight hematomas were located in the cervical, two in the cervicothoracic, and three in the thoracic region. Two others were situated in the lumbar spine. Mean extension was 4.7 segments (range, 2-8 segments). Mean interval between onset of symptoms and surgery was 18 hours (range, 8-48 hours) for 12 patients; in 2 cases, diagnosis was made after 17 and 36 days, respectively, and then treated by surgery. One patient was treated without operation. Operative treatment was accomplished in all cases by hemilaminectomy and/or interlaminar fenestration and hematoma evacuation, in those cases with a larger extension of extradural hematoma by an alternating hemilaminectomy, thus reducing the risk of postoperative instability. There was no recurrence. No correlation between time to surgery and outcome was found in this study group, but there was a strong correlation between initial neurologic status and outcome after surgery.
Nonsurgical derived spinal hematomas are rare. In this series, most cases were spontaneous and located in the cervical or cervicothoracic region producing severe neurologic deficit and pain. Treatment should be surgical evacuation in the majority. As most hematomas are of great extension, alternating hemilaminectomy suffices for evacuation of extradural hematomas and supports the stability of the spinal segments. Outcome is highly dependent from initial neurologic status.
回顾性临床研究。
确定一组非因既往手术所致的脊柱血肿患者的特征、治疗方法及预后。
回顾并分析1993年1月至2002年12月间在我院接受治疗的所有脊柱血肿患者的病历，内容包括血肿的位置及范围、症状持续时间、神经功能状态、诊断措施、治疗方法及预后。
确定15例非因既往脊柱手术所致的脊柱血肿患者。其中女性11例，男性4例。1例血肿位于硬膜下，1例位于髓内。其余所有血肿均位于硬膜外，其中10例为自发性出血。8例血肿位于颈椎，2例位于颈胸段，3例位于胸段。另外2例位于腰椎。平均范围为4.7个节段（范围为2 - 8个节段）。12例患者症状出现至手术的平均间隔时间为18小时（范围为8 - 48小时）；2例患者分别在17天和36天后确诊，随后接受手术治疗。1例患者未接受手术治疗。所有病例均通过半椎板切除术和/或椎板间开窗术及血肿清除术进行手术治疗，对于硬膜外血肿范围较大的病例采用交替半椎板切除术，从而降低术后不稳定的风险。无复发情况。本研究组未发现手术时间与预后之间存在相关性，但发现初始神经功能状态与术后预后之间存在密切相关性。
非手术源性脊柱血肿较为罕见。在本系列研究中，大多数病例为自发性，位于颈椎或颈胸段，可导致严重的神经功能缺损和疼痛。大多数情况下应进行手术清除血肿。由于大多数血肿范围较大，交替半椎板切除术足以清除硬膜外血肿并维持脊柱节段的稳定性。预后高度依赖于初始神经功能状态。
