Wang Lushun, Liu Gabriel, Subramaniam Sivashankar, Wong Thomas Aloysius Kah Wai, Kumar Naresh
Department of Orthopaedics, National University Hospital, Singapore.
J Orthop Surg (Hong Kong). 2012 Dec;20(3):386-90. doi: 10.1177/230949901202000326.
We report 2 cases of spontaneous spinal epidural haematoma after antiplatelet treatment. One patient was on ticlodipine therapy and the other was on aspirin and clopidogrel. Both diagnoses were made using magnetic resonance imaging. One patient underwent multilevel laminectomies and posterior spinal fusion within 24 hours of symptom onset and achieved complete neurological recovery. The other underwent unilateral hemilaminectomies 40 hours after symptom onset and did not show neurological improvement. A high index of suspicion is needed for patients presenting with severe lower back pain and rapid neurological deterioration, especially in those on antiplatelet therapy. Urgent spinal cord decompression and epidural haematoma cord evacuation may provide more favourable outcome.
我们报告了2例抗血小板治疗后发生的自发性脊髓硬膜外血肿病例。1例患者正在接受噻氯匹定治疗，另1例正在服用阿司匹林和氯吡格雷。二者均通过磁共振成像确诊。1例患者在症状出现后24小时内接受了多节段椎板切除术和后路脊柱融合术，神经功能完全恢复。另1例在症状出现后40小时接受了单侧半椎板切除术，但神经功能未改善。对于出现严重腰痛和迅速神经功能恶化的患者，尤其是正在接受抗血小板治疗的患者，需要高度怀疑此病。紧急脊髓减压和硬膜外血肿清除术可能会带来更有利的结果。
