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一例伴有骨质疏松性椎体压缩骨折的复发性创伤性硬脊膜外血肿的罕见病例:病例报告。

An unusual case of recurrent traumatic spinal epidural hematoma accompanied by osteoporotic vertebral compression fractures: Case report.

机构信息

Department of Orthopedics, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Traditional Medicine University, Zhejiang, China.

Department of Orthopedics, Zhengzhou Orthopedic Hospital, Henan University, Henan, China.

出版信息

Medicine (Baltimore). 2024 Oct 4;103(40):e39650. doi: 10.1097/MD.0000000000039650.

DOI:10.1097/MD.0000000000039650
PMID:39465779
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11460909/
Abstract

RATIONALE

Traumatic spinal epidural hematoma (SEH) is a rare clinical condition. Here, we present an extraordinary case of recurrent SEH accompanied by thoracolumbar spine fractures resulting from minor trauma, and provide evidence-based recommendations for the surgical management strategies in this unique scenario.

PATIENT CONCERNS

A 71-year-old female patient presented with back pain after a fall. Magnetic resonance imaging revealed an SEH with L2 vertebral compression fracture. Following unsuccessful conservative treatment, percutaneous vertebroplasty was performed at the 2nd lumbar vertebra under local anesthesia. Two years later, the patient experienced another fall and was diagnosed with spinal hematoma with L1 vertebral compression fractures.

DIAGNOSES

The patient was diagnosed with recurrent osteoporotic vertebral compression fracture accompanying SEH.

OUTCOMES

After 1 week of conservative treatment, notable improvement of limbs numbness was observed. The patient ultimately underwent L1 vertebroplasty surgery. The patient was discharged smoothly on the third postoperative day and made a full recovery after 4 months.

LESSONS

SEH is a rare clinical finding that can occur even after a minor trauma in the elderly. It is worth noting that osteoporotic vertebral compression fractures with asymptomatic or stable intraspinal hematoma, is not considered to be a contraindication for percutaneous vertebroplasty. And percutaneous vertebroplasty is a safe and effective treatment for osteoporotic compression fractures with asymptomatic SEH.

摘要

背景

创伤性硬脊膜外血肿(SEH)是一种罕见的临床病症。在此,我们报告一例罕见的复发性 SEH 病例,该患者因轻微外伤导致胸腰椎骨折,并为这种独特情况下的手术治疗策略提供了循证推荐。

病例概述

一名 71 岁女性患者在跌倒后出现背痛。磁共振成像显示 L2 椎体压缩性骨折合并 SEH。在局部麻醉下行第 2 腰椎经皮椎体成形术治疗后,保守治疗失败。两年后,患者再次跌倒,被诊断为 L1 椎体压缩性骨折合并脊髓血肿。

诊断

患者被诊断为复发性骨质疏松性椎体压缩骨折合并 SEH。

治疗结果

经过 1 周的保守治疗,患者四肢麻木症状明显改善。最终,患者接受了 L1 椎体成形术。术后第 3 天患者顺利出院,4 个月后完全康复。

教训

SEH 是一种罕见的临床病症,即使是老年人,轻微外伤也可能导致 SEH。需要注意的是,对于无症状或稳定的椎管内血肿的骨质疏松性椎体压缩骨折,不应视为经皮椎体成形术的禁忌证。对于无症状 SEH 的骨质疏松性压缩性骨折,经皮椎体成形术是一种安全有效的治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c704/11460909/e72b5ab4ae3f/medi-103-e39650-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c704/11460909/d5ec2b3b22a2/medi-103-e39650-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c704/11460909/e72b5ab4ae3f/medi-103-e39650-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c704/11460909/d5ec2b3b22a2/medi-103-e39650-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c704/11460909/e72b5ab4ae3f/medi-103-e39650-g002.jpg

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本文引用的文献

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Spinal Hematomas: What a Radiologist Needs to Know.脊髓血肿:放射科医生需要了解的知识。
Radiographics. 2018 Sep-Oct;38(5):1516-1535. doi: 10.1148/rg.2018180099.
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Rapid Recovery of Spontaneous Spinal Epidural Hematoma without Surgical Treatment: Case Report and Literature Review.无需手术治疗的自发性脊髓硬膜外血肿快速恢复:病例报告及文献综述
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