Li Jia, Qi Ke, Zhang Yongjin, Xue Chenchen, Xu Weidong
Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China.
Medicine (Baltimore). 2017 May;96(19):e6859. doi: 10.1097/MD.0000000000006859.
Ankylosing spondylitis (AS) can affect the hip joint, causing deformity and disability. Total hip arthroplasty can obviously relieve the pain of the hip joint, and reconstruct the function of hip joint. Epidural anesthesia in this patient population has high risk of epidural hematoma, but the reason is unclear.
A 44-year-old man diagnosed with AS underwent total hip arthroplasty.
Six days after operation, he was diagnosed epidural hematoma.
Laminectomy and decompression surgery was performed.
At the last follow-up, he recovered the feeling and function of lower limbs. A literature review was undertaken to understand the incidence and risk factors. The incidence of spinal hematoma in this population is high and only probable risk factors are reported without further research.
Based on our review and the illustration of this case, AS patients have both lumbar and hip bony fusion. The exact bone canal caused by the lumbar puncture needle may play an important role in epidural hematoma. General anesthesia may be a better choice for this special patient cohort.
强直性脊柱炎（AS）可累及髋关节，导致畸形和残疾。全髋关节置换术能明显缓解髋关节疼痛，重建髋关节功能。在这类患者中，硬膜外麻醉发生硬膜外血肿的风险较高，但原因尚不清楚。
一名44岁诊断为AS的男性接受了全髋关节置换术。
术后6天，他被诊断为硬膜外血肿。
进行了椎板切除减压手术。
在最后一次随访时，他恢复了下肢的感觉和功能。进行了文献综述以了解发病率和危险因素。该人群中脊髓血肿的发病率较高，仅报道了可能的危险因素，尚无进一步研究。
根据我们的综述和该病例说明，AS患者存在腰椎和髋关节骨质融合。腰椎穿刺针造成的确切骨管可能在硬膜外血肿中起重要作用。对于这一特殊患者群体，全身麻醉可能是更好的选择。
