CAJ | 학술논문

目的分析和探讨急性自发性硬脊膜外血肿(ASSEH)的临床特征、诊断和治疗.方法对5例经手术证实的ASSEH病例的诊断和显微手术治疗进行回顾性分析.5例患者主要临床症状为突发颈肩部/腰背部剧痛,并迅速出现迟缓性瘫痪和植物神经功能障碍.MRI检查均表现为椎管内硬膜外条状或梭形病灶,边界清楚,未见强化.急诊在显微镜下行后路椎管探查椎板切除血肿清除术.结果所有患者手术经过顺利,术中见血肿位置与MRI提示的一致,清除褐色胶冻样血肿5～15 ml,显微镜下未见蛛网膜下隙和脊髓异常.按照国际脊髓损伤神经分类标准评分,术后11～30 d神经功能从术前的B、C级均恢复到E级,未有并发症发生.随访1～6个月均未见异常.结论结合临床症状和MRI可提高ASSEH正确诊断率,而术前行数字减影血管造影(DSA)并非必要.急诊显微神经外科手术是治疗症状性ASSEH的有效手段,术后DSA有助于排除脊髓血管畸形.
목적 분석화탐토급성자발성경척막외혈종(ASSEH)적림상특정、진단화치료.방법 대5례경수술증실적ASSEH병례적진단화현미수술치료진행회고성분석.5례환자주요림상증상위돌발경견부/요배부극통,병신속출현지완성탄탄화식물신경공능장애.MRI검사균표현위추관내경막외조상혹사형병조,변계청초,미견강화.급진재현미경하행후로추관탐사추판절제혈종청제술.결과 소유환자수술경과순리,술중견혈종위치여MRI제시적일치,청제갈색효동양혈종5～15 ml,현미경하미견주망막하극화척수이상.안조국제척수손상신경분류표준평분,술후11～30 d신경공능종술전적B、C급균회복도E급,미유병발증발생.수방1～6개월균미견이상.결론 결합림상증상화MRI가제고ASSEH정학진단솔,이술전행수자감영혈관조영(DSA)병비필요.급진현미신경외과수술시치료증상성ASSEH적유효수단,술후DSA유조우배제척수혈관기형.
Objective To investigate the diagnosis and the effect of microsurgery in patients with acute spontaneous spinal epidural hematoma (ASSEH). Method Five patients with ASSEH treated with microsurgery and confirmed pathologically were retrospectively analyzed. Results The main clinical presentations were root pain and palsy. The main manifestations of MRI were long-segment epidural lesion of high intensity in T1 and T2-weighted images without enhancement. With the microsurgery system, laminectomy via posterior approach and hematoma removal were successfully undergone with full recovery in all cases. Conclusions MRI assisted with the main clinical symptoms may aid preoperative diagnosis in symptomatic ASSEH. Microsurgery is an effective method for treating ASSEH. Postoperative (rather than preoperative) spinal DSA is advantageous for exclusion of spinal vascular malformation in treating ASSEH.