Ye X W, Liu S S, Zeng P H, Liu B L
Department of Spine Surgery, Fuzhou Second Hospital of Xiamen University, Fuzhou 350007, China.
Zhonghua Wai Ke Za Zhi. 2017 Nov 1;55(11):877-880. doi: 10.3760/cma.j.issn.0529-5815.2017.11.013.
Symptomatic spinal epidural hematoma (SSEH) following spinal surgery is rare but one of the serious complications. SSEH can leave devastating neurological consequences if missing the optimal timing for treatment. The early diagnosis of SSEH is critical to the neurologic recovery, and MRI examination can help to check the location and the scope of the hematoma and provide imaging information for surgical operation. The risk factors of SSEH can be divided into preoperative factors, intraoperative factors and postoperative factors. The occurrence of SSEH can be minimized by controlling the risk factors, exact hemostasis and reasonable perioperative management. Patients with mild paralysis can choose conservative treatment, while patients with severe or progressive nerve injury (manual muscle testing <3) and unendurable nerve root pain should choose to clean the hematoma and decompress the nerve as soon as possible.
脊柱手术后发生的症状性脊髓硬膜外血肿(SSEH)虽罕见,但却是严重并发症之一。若错过最佳治疗时机,SSEH可导致严重的神经功能后果。SSEH的早期诊断对神经功能恢复至关重要,MRI检查有助于明确血肿的位置和范围,为手术提供影像学信息。SSEH的危险因素可分为术前因素、术中因素和术后因素。通过控制危险因素、精确止血及合理的围手术期管理,可将SSEH的发生率降至最低。轻度瘫痪的患者可选择保守治疗,而重度或进行性神经损伤(徒手肌力测试<3级)且神经根疼痛难以忍受的患者应尽早选择清除血肿并进行神经减压。