胸椎椎管狭窄症术后急性硬脊膜外血肿

目的探讨胸椎椎管狭窄症术后急性硬脊膜外血肿的成因、诊断、治疗及预防措施。方法回顾性分析2003年6月～2011年12月因胸椎椎管狭窄症给予后路全椎板减压手术的患者101例,其中术后经再次手术证实术区急性硬脊膜外血肿9例,对其临床表现与再次手术情况进行分析。结果 9例患者全部获得随访,随访时间为3～45个月,平均34个月。血肿清除前神经功能评分为0.89±0.78,血肿清除后的神经功能评分为2.33±1.22,与术前相比差异有统计学意义（t=4.91,P〈0.01）。硬膜外血肿压迫时间为（7.72±7.06）min,血肿清除后神经功能恢复率与血肿压迫时间呈负相关（r=-0.789 6,P〈0.01）。结论胸椎椎管狭窄症手术后急性硬膜外血肿应尽快手术减压,血肿清除越早,术后神经功能恢复越好。

Acute spinal epidural hematoma after decompression of thoracic spinal stenosis

Objective To explore the risk factors,diagnosis,treatments and prevention for acute spinal epidural hematoma after decompression of thoracic spinal stenosis.Methods From June 2003 to December 2011,101 patients with thoracic spinal stenosis underwent laminectomy through posterior approach.Acute epidural hematoma ocurred in 9 patients after the operation,which was confirmed by the secondary surgical treatment.The clinical manifestation and the detail of the secondary surgery were retrospectively analyzed.Results All the 9 patients were followed up from 3 to 45 months(mean 34 months).The neurological function scores were 0.89±0.78 and 2.33±1.22 before and after hematoma(t=4.91,P<0.01),respectively.The average duration of epidural hematoma was(7.72±7.06) min.The recovery of neurological function was negatively correlated with the duration of hematoma(r=-0.789 6,P<0.01).Conclusion Spinal decompression should be performed as soon as possible for the epidural hematoma after thoracic laminectomy.The earlier removal of hematoma,the better recovery of neurological function.