Norton Leatherman Spine Center, 210 East Gray Street, #900, Louisville, KY 40202, USA.
Norton Leatherman Spine Center, 210 East Gray Street, #900, Louisville, KY 40202, USA.
Orthop Clin North Am. 2022 Jan;53(1):113-121. doi: 10.1016/j.ocl.2021.08.006. Epub 2021 Oct 28.
Symptomatic postoperative epidural hematomas are rare, with an incidence of 0.10% to 0.69%. Risk factors have varied in the literature, but multiple studies have reported advanced age, preoperative or postoperative coagulopathy, and multilevel laminectomy as risk factors for hematoma. The role of pharmacologic anticoagulation after spine surgery remains unclear, but multiple studies suggest it can be done safely with a low risk of epidural hematoma. Prophylactic suction drains have not been found to lower hematoma incidence. Most symptomatic postoperative epidural hematomas present within the first 24 to 48 hours after surgery but can present later. Diagnosis of a symptomatic hematoma requires correlation of clinical signs and symptoms with a compressive hematoma on MRI. Patients will usually first complain of a marked increase in axial pain, followed by radicular symptoms in the extremities, followed by motor weakness and sphincter dysfunction. An MRI should be obtained emergently, and if it confirms a compressive hematoma, surgical evacuation should be carried out as quickly as possible. The prognosis for neurologic improvement after evacuation depends on the time delay and the degree of neurologic impairment before evacuation.
术后症状性硬膜外血肿罕见，发病率为 0.10%至 0.69%。文献中的危险因素各不相同，但多项研究报告称，高龄、术前或术后凝血功能障碍以及多节段椎板切除术是血肿的危险因素。脊柱手术后使用药物抗凝的作用仍不清楚，但多项研究表明，在低硬膜外血肿风险下可以安全进行。预防性抽吸引流并不能降低血肿的发生率。大多数症状性术后硬膜外血肿在术后 24 至 48 小时内出现，但也可能延迟出现。症状性血肿的诊断需要将临床体征和症状与 MRI 上的压迫性血肿进行关联。患者通常首先会抱怨轴向疼痛明显增加，随后出现四肢神经根症状，然后出现运动无力和括约肌功能障碍。应立即进行 MRI，如果证实为压迫性血肿，则应尽快进行手术清除。清除后神经功能改善的预后取决于清除前的时间延迟和神经功能损伤程度。
