摘要
目的：探讨腰椎减压内固定术后硬膜外血肿形成的原因、诊治及预防对策。方法2089例接受腰椎后路减压内固定手术的患者中,术后发生硬膜外血肿7例,均行急诊手术探查并清除血肿；分析其硬膜外血肿形成的原因,探讨预防对策。结果7例术后硬膜外血肿患者的首发症状均为神经功能减退,其中6例表现出下肢神经症状进行性加重,1例小便障碍。5例术后24 h内行椎管探查术,2例24∽48 h内行椎管探查术。4例术前经MRI确诊有硬膜外血肿,3例未行MRI检查。术后随访1年,手术探查清除血肿越早患者神经功能恢复越好。结论硬膜外血肿的形成与多节段减压、止血材料使用不当、使用抗凝剂及止血不彻底等因素有关,术后密切观察病情、早期MRI确诊和及时的椎管探查手术,是预防和治疗术后硬膜外血肿的主要方法。
Objective To investigate the reason,discuss its diagnosis,treatment and prevention of the spinal epidural hematoma （ SEH） following decompression and internal fixation of lumbar spine. Methods 2 089 cases with decom-pression and internal fixation of lumbar spine were enrolled. Seven cases had SEH after the primary surgery and were treated by hematoma evacuation and decompression. Preventive countermeasures of the SEH were assessed. Results Neurological deterioration was the initial symptom in 7 cases of SEH. Six cases showed lower limb progressive and se-vere neurologic deficit, one case showed urine dysfunction. Surgical exploration was performed when primary surgery was performed within 24 h in 5 cases, between 24∽48 h in 2 cases. Four cases were confirmed by MRI before surgi-cal exploration, three cases were not confirmed by MRI before surgical exploration. During the follow-up of 12 months, neurological function recovery of the patient who had surgery exploration in time was better than the delayed. Conclusions These factors such as multilevel procedure, hemostatic materials improper use,using chemical antico-agulation and stanching not completely are associated with SEH. Close observation following the operation, early diag-nosis by MRI and surgery exploration performed in time are the key measures to prevent and treat SEH.
出处
《临床骨科杂志》
2015年第4期414-417,共4页
Journal of Clinical Orthopaedics
关键词
腰椎减压
内固定术
硬膜外血肿
lumbar spine decompression
internal fixation
spinal epidural hematoma
