Kamoda Hiroto, Ishikawa Tetsuhiro, Miyagi Masayuki, Eguchi Yawara, Orita Sumihisa, Suzuki Miyako, Sakuma Yoshihiro, Oikawa Yasuhiro, Yamauchi Kazuyo, Inoue Gen, Takahashi Kazuhisa, Ohtori Seiji
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan ; Department of Orthopaedic Surgery, Chiba Cancer Center, 666-2 Nitona, Chuo-ku, Chiba 260-8717, Japan.
Case Rep Orthop. 2013;2013:861961. doi: 10.1155/2013/861961. Epub 2013 Sep 1.
We present a rare case of delayed onset of epidural hematoma after lumbar surgery whose only presenting symptom was vesicorectal disturbance. A 68-year-old man with degenerative spinal stenosis underwent lumbar decompression and instrumented posterolateral spine fusion. The day after his discharge following an unremarkable postoperative course, he presented to the emergency room complaining of difficulty in urination. An MRI revealed an epidural fluid collection causing compression of the thecal sac. The fluid was evacuated, revealing a postoperative hematoma. After removal of the hematoma, his symptoms disappeared immediately, and his urinary function completely recovered. Most reports have characterized postoperative epidural hematoma as occurring early after operation and accompanied with neurological deficits. But it can happen even two weeks after spinal surgery with no pain. Surgeons thus may need to follow up patients for at least a few weeks because some complications, such as epidural hematomas, could take that long to manifest themselves.
我们报告一例腰椎手术后延迟出现硬膜外血肿的罕见病例，其唯一的表现症状是膀胱直肠功能障碍。一名患有退行性脊柱狭窄的68岁男性接受了腰椎减压和后路外侧脊柱内固定融合术。术后过程平稳，出院次日，他因排尿困难前往急诊室就诊。磁共振成像（MRI）显示硬膜外有液体积聚，压迫硬脊膜囊。抽出液体后，发现是术后血肿。清除血肿后，他的症状立即消失，排尿功能完全恢复。大多数报告将术后硬膜外血肿描述为术后早期发生并伴有神经功能缺损。但即使在脊柱手术后两周也可能发生且无疼痛症状。因此，外科医生可能需要对患者至少随访几周，因为一些并发症，如硬膜外血肿，可能需要这么长时间才会显现出来。
