自发性椎管内硬膜外血肿的临床诊治分析

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摘要：目的 探讨自发性椎管内硬膜外血肿的病因、临床表现、影像学特征、治疗方法及预后。方法 回顾性分析2010年1月～2014年12月收治的12例自发性椎管内硬膜外血肿患者的临床资料。其中手术11例，保守治疗1例。结果 11例手术病例中，术后病理提示脊膜瘤1例，动静脉畸形1例，余9例为原因不明的椎管内硬膜外血肿。11例术后复查MRI提示血肿清除。所有患者出院后随访6～20个月，11例手术患者感觉均已恢复，5例术前括约肌功能障碍者均已恢复，7例手术患者肌力完全恢复，3例手术患者肌力从0～1级恢复至4级，1例手术患者肌力从0级恢复至3级。1例保守治疗者复查MRI提示血肿吸收。结论 自发性椎管内硬膜外血肿临床上少见，MRI是首选的检查方法。治疗上以椎板减压血肿清除术为主要手术方式，部分血肿较少且症状较轻者可选择保守治疗。预后主要与术前神经功能障碍程度、病变的节段和范围、起病到手术的时间间隔等有关。

关键词：自发性椎管内硬膜外血肿；诊断；治疗；预后

Abstract：Objective To study the etiology， clinical presentation， imaging feature， treatment and prognosis of spontaneous spinal epidural hematomas. Methods The clinical data of 12 patients with spontaneous spinal epidural hematomas treated in our hospital from January， 2010 to December ， 2014 were analyzed retrospectively. Of 12 patients with spontaneous spinal epidural hematomas， 11 were treated surgically and one conservatively. Results The pathological examination showed that， of 11 patients treated surgically， 1 suffered from spinal meningioma， 1 from arteriovenous malformations， and 9 had spinal epidural hematomas which were produced by the undefined causes. The postoperative MRI showed that the spontaneous spinal epidural hematomas were evacuated. The patients were followed up from 6 to 20 months. In the 11 patients undergone the surgery， the body feelings were all recovered， the sphincter function were completely recovered in 5 cases， the body movement were recovered in 7 cases， the muscle strength recovered from level zero or one to level four in 3 cases and from level zero to level three in 1 case. Following up by MRI showed that the hematomas were absorbed after the conservative treatment in one patients. Conclusion Spontaneous spinal epidural hematomas are rare entities. The optimal diagnostic tool is MR imaging. The laminectomy and evacuation of hematoma for the decompression is the standard management for spontaneous spinal epidural hematomas. Conservative treatment is also feasible in the selected patients with spontaneous spinal epidural hematomas. The prognoses in the patients with spontaneous spinal epidural hematomas are related to the preoperative status of the neurological deficit， the interval between the hemorrhage and the operation， and the location and scope of the hematoma.

Key words：Spontaneous spinal epidural hematoma； Diagnosis； Treatment； Prognosis

自发性椎管内硬膜外血肿（spontaneous spinal epidural hematoma，SSEH）是一种原因不清，血液积聚在椎管内硬膜外区域，引起神经压迫为特征的疾病。本病临床上较少见，容易误诊漏诊，每年发病率为0.1/100，000，在椎管内硬膜外占位性病变中的比重小于1%[1]。临床表现通常为急性起病，出现严重的颈部或腰背痛，随后出现神经根或脊髓压迫的症状和体征。文献报道椎板减压血肿清除术是主要的手术方式，对于症状较轻且稳定或症状逐渐好转者可行保守治疗[2]。本文回顾性分析我科自2010年1月～2014年12月收治的12例SSEH患者，现将其临床特点及治疗经过报道如下。