颈椎前路术后早期硬膜外血肿形成的原因及防治

摘要

目的:探讨颈椎前路术后早期硬膜外血肿形成的原因及防治措施.方法:2005年6月至2011年12月,行颈椎前路手术的患者1 452例,术后发生硬膜外血肿5例,男4例,女1例；年龄33～55岁,平均46.4岁；脊髓型颈椎病3例,脊髓型颈椎病伴C6椎体血管瘤1例,颈椎后纵韧带骨化症1例.回顾分析5例硬膜外血肿出现的时间、临床表现、症状持续时间及手术处理对神经功能恢复的影响.结果:5例患者均出现在术后24 h内,平均症状持续时间4 h(2～7 h),表现为进行性加重的脊髓功能损害,均行急诊手术处理,术后患者脊髓功能均有不同程度地恢复,1例患者在第1次血肿清除术后5h再次出现血肿压迫而行第2次血肿清除术；术后平均随访13.8个月(6～18个月),至末次随访时神经功能均恢复良好,无硬膜外血肿复发.结论:颈椎前路术后24 h内,特别是术后6～8 h,是硬膜外血肿发生的高峰,应严密监测患者神经功能变化；早期出现的进行性加重的脊髓功能损害是硬膜外血肿的主要临床表现；MRI检查可以明确硬膜外血肿的诊断,并可以精确定位血肿位置和范围,有助于硬膜外血肿的有效清除.硬膜外血肿一旦确诊必须第一时间行手术治疗,如果处理及时患者脊髓功能恢复良好.%Objective: To explore the risk factors, preventive measure of epidural hematoma after anterior cervical operation. Methods:From June 2005 and December 2012,1 452 patients underwent anterior cervical operation in our hospital. Epidural hematoma occurred in 5 cases after operation and the incidence rate was 0.34%. There were 4 males and 1 female with an average age of 46.4 years (ranged,33 to 55) ;3 cases with cervical myelopathy, 1 case with cervical myelopathy and C6 vertebral angeioma, 1 case with ossification of cervical posterior longitudinal ligament. The occurred time,main clinical situation , duration of symptoms, operative management of epidural hematoma were analyzed. Results: Five patients with epidural hematoma occurred within 24 h; the average interval between onset of symptoms and surgery was 4 h (ranged,2 to 7). Operative treatment was accomplished in 5 cases by exploration and hematoma evacuation. There was significant improvement in all patients after reoperation. Epidural hematoma occurred again in one patient at 5 h after hematoma evacuation, and reoperation were performed to treat it. All patients were followed up from 6 tol8 months with an average of 13.8 months. No recurrence was found. Conclusion: Intensive care in 24 h postoperatively is important because of epidural hematoma often occurs in this period, especialy in the period of 6-8 h postoperativey. Clinical findings and MRI can early diagnose epidural hematoma and help treatment. Once it is identified and surgical evacuation would be performed on time.