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全膝关节置换术前脊柱硬膜外麻醉后发生硬膜下血肿1例报告

A Case Report of a Subdural Hematoma following Spinal Epidural prior to a Total Knee Arthroplasty.

作者信息

Carlson Brian J, Deckey David G, Clarke Henry D, Bingham Joshua S

机构信息

Elson S. Floyd College of Medicine, Washington State University, USA.

Department of Orthopedics, Mayo Clinic Arizona, USA.

出版信息

Case Rep Orthop. 2022 Jun 2;2022:7548593. doi: 10.1155/2022/7548593. eCollection 2022.

DOI:10.1155/2022/7548593
PMID:35692943
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9184218/
Abstract

INTRODUCTION

This case report adds to current literature on management of a subdural hematoma following total knee arthroplasty and is particularly important as joint replacement moves into outpatient surgery centers where the orthopedic surgery team becomes the sole patient contact point. . A 66-year-old male presented to the emergency department five days after elective robotic-assisted left total knee arthroplasty performed with spinal epidural with the symptoms of a persistent nonpostural headache. CT of the head revealed a small bifrontal acute subdural hematoma. He was admitted for overnight monitoring as a precaution. No vascular abnormalities or underlying pathology was found on further advanced imaging. He was discharged the following morning after follow-up CT showed no focal changes. Magnetic resonance imaging (MRI) one month later confirmed resolution of the subdural hematoma.

CONCLUSION

Orthopedic surgeons should be aware of the signs and symptoms, as well as the risk factors for subdural hematomas following lumbar puncture, as it is a rare, but potentially life-threatening complication of spinal epidural.

摘要

引言

本病例报告补充了目前关于全膝关节置换术后硬膜下血肿管理的文献，随着关节置换手术进入门诊手术中心，骨科手术团队成为唯一的患者接触点，这一报告尤为重要。一名66岁男性在择期机器人辅助下进行左全膝关节置换术后五天，因持续非体位性头痛症状就诊于急诊科，该手术采用脊髓硬膜外麻醉。头部CT显示双侧额叶有一小的急性硬膜下血肿。作为预防措施，他被收治进行过夜监测。进一步的高级影像学检查未发现血管异常或潜在病变。随访CT显示无局灶性变化后，他于次日早晨出院。一个月后的磁共振成像（MRI）证实硬膜下血肿已消退。

结论

骨科医生应了解腰椎穿刺后硬膜下血肿的体征和症状以及危险因素，因为这是脊髓硬膜外麻醉一种罕见但可能危及生命的并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/c5c46ed7e573/CRIOR2022-7548593.009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/82f4db71907c/CRIOR2022-7548593.001.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/5d69180adb6e/CRIOR2022-7548593.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/1c057f42684c/CRIOR2022-7548593.004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/fe43df534722/CRIOR2022-7548593.005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/06f0cea105d5/CRIOR2022-7548593.006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/b837f74f11af/CRIOR2022-7548593.007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/8d8a4c6c37aa/CRIOR2022-7548593.008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/c5c46ed7e573/CRIOR2022-7548593.009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/82f4db71907c/CRIOR2022-7548593.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/e8e0b22c5b52/CRIOR2022-7548593.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/5d69180adb6e/CRIOR2022-7548593.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/1c057f42684c/CRIOR2022-7548593.004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/fe43df534722/CRIOR2022-7548593.005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/06f0cea105d5/CRIOR2022-7548593.006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/b837f74f11af/CRIOR2022-7548593.007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/8d8a4c6c37aa/CRIOR2022-7548593.008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d94d/9184218/c5c46ed7e573/CRIOR2022-7548593.009.jpg

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本文引用的文献

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Association Between Post-Dural Puncture Headache After Neuraxial Anesthesia in Childbirth and Intracranial Subdural Hematoma.分娩椎管内麻醉后头痛与颅内硬脑膜下血肿的关系。
JAMA Neurol. 2020 Jan 1;77(1):65-72. doi: 10.1001/jamaneurol.2019.2995.
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Association of Antithrombotic Drug Use With Subdural Hematoma Risk.抗血栓药物的使用与硬膜下血肿风险的关系。
JAMA. 2017 Feb 28;317(8):836-846. doi: 10.1001/jama.2017.0639.
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Recurrent Cranial Chronic Subdural Hematoma due to Cervical Cerebrospinal Fluid Fistula: Repair of Both Entities in the Same Session.
因颈脑脊液瘘导致的复发性颅骨慢性硬膜下血肿：同次手术修复两种病症
J Craniofac Surg. 2016 Sep;27(6):e578-80. doi: 10.1097/SCS.0000000000002882.
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Delayed Onset Intracranial Subdural Hematoma Following Spinal Surgery.脊柱手术后迟发性颅内硬膜下血肿
J Craniofac Surg. 2016 Jun;27(4):e370-3. doi: 10.1097/SCS.0000000000002632.
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Spontaneous rapid resolution of acute subdural hematoma in children.儿童急性硬膜下血肿的自发快速消退
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Unintentional dural puncture and postdural puncture headache-can this headache of the patient as well as the anaesthesiologist be prevented?意外硬膜穿刺和硬膜穿刺后头痛——患者以及麻醉医生的这种头痛能够预防吗？
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The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development.《CARE指南：基于共识的临床病例报告指南制定》
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