Lawton M T, Porter R W, Heiserman J E, Jacobowitz R, Sonntag V K, Dickman C A
Division of Neurological Surgery, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
J Neurosurg. 1995 Jul;83(1):1-7. doi: 10.3171/jns.1995.83.1.0001.
Thirty patients were treated surgically for spinal epidural hematoma (SEH). Twelve of these cases resulted from spinal surgery, seven from epidural catheters, four from vascular lesions, three from anticoagulation medications, two from trauma, and two from spontaneous causes. Pain was the predominant initial symptom, and all patients developed neurological deficits. Eight patients had complete motor and sensory loss (Frankel Grade A); six had complete motor loss but some sensation preserved (Frankel Grade B); and 16 had incomplete loss of motor function (10 patients Frankel Grade C and six patients Frankel Grade D). The average interval from onset of initial symptom to maximum neurological deficit was 13 hours, and the average interval from onset of symptom to surgery was 23 hours. Surgical evacuation of the hematoma was performed in all patients; 26 of these improved; four remained unchanged, and no patients worsened (mean follow up 11 months). Complete recovery (Frankel Grade E) was observed in 43% of the patients and functional recovery (Frankel Grades D or E) was observed in 87%. One postoperative death occurred from a pulmonary embolus (surgical mortality 3%). Preoperative neurological status correlated with outcome; 83% of Frankel Grade D patients recovered completely compared to 25% of Frankel Grade A patients. The rapidity of surgical intervention also correlated with outcome; greater neurological recovery occurred as the interval from symptom onset to surgery decreased. Patients taken to surgery within 12 hours had better neurological outcomes than patients with identical preoperative Frankel grades whose surgery was delayed beyond 12 hours. This large series of SEH demonstrates that rapid diagnosis and emergency surgical treatment maximize neurological recovery. However, patients with complete neurological lesions or long-standing compression can improve substantially with surgery.
30例患者接受了脊髓硬膜外血肿（SEH）的手术治疗。其中12例由脊柱手术引起，7例由硬膜外导管引起，4例由血管病变引起，3例由抗凝药物引起，2例由外伤引起，2例由自发原因引起。疼痛是主要的初始症状，所有患者均出现神经功能缺损。8例患者出现完全运动和感觉丧失（Frankel A级）；6例患者出现完全运动丧失但仍保留一些感觉（Frankel B级）；16例患者出现运动功能不完全丧失（10例Frankel C级患者和6例Frankel D级患者）。从初始症状出现到最大神经功能缺损的平均间隔时间为13小时，从症状出现到手术的平均间隔时间为23小时。所有患者均进行了血肿的手术清除；其中26例病情改善；4例病情无变化，无患者病情恶化（平均随访11个月）。43%的患者实现了完全恢复（Frankel E级），87%的患者实现了功能恢复（Frankel D级或E级）。1例患者术后死于肺栓塞（手术死亡率3%）。术前神经状态与预后相关；Frankel D级患者中有83%完全恢复，而Frankel A级患者中这一比例为25%。手术干预的速度也与预后相关；随着从症状出现到手术的间隔时间缩短，神经恢复程度更高。在12小时内接受手术的患者比术前Frankel分级相同但手术延迟超过12小时的患者具有更好的神经功能预后。这一大组SEH病例表明，快速诊断和紧急手术治疗可使神经恢复最大化。然而，患有完全神经损伤或长期受压的患者通过手术也可大幅改善。
