CAJ | 학술논문

目的探讨胸椎手术后急性硬脊膜外血肿的形成原因、血肿压迫时间对脊髓神经功能的影响及预防措施.方法回顾性分析2002年5月至2012年5月经手术证实的胸椎后路手术后发生急性硬脊膜外血肿致神经功能障碍的14例患者资料,男6例,女8例；年龄41～69岁,平均61.2岁；胸椎管狭窄症10例,胸椎管内脊膜瘤3例,胸椎转移瘤1例；胸椎后路手术后3～14 h,平均6.6h,患者脊髓神经功能出现恶化,ASIA分级A级5例,B级9例.对比血肿清除前、后以及随访时患者神经功能评分及神经功能恢复率.分析神经功能恢复率与血肿压迫时间及血肿清除前神经功能的关系.结果 14例患者血肿清除后AISA分级为:B级1例,C级2例,D级4例,E级7例.其中 B、C级3例患者血肿压迫时间均＞10 h.血肿清除前、后神经功能比较差异有统计学意义,血肿清除后神经功能恢复率为63.7％±23.3％,与血肿压迫时间呈负相关,与血肿清除前神经功能呈正相关.血肿清除前神经功能与随访神经功能比较差异有统计学意义,随访神经功能恢复率为86.97％±17.58％,与血肿压迫时间呈负相关,与血肿清除术前神经功能呈正相关.结论胸椎术后急性硬脊膜外血肿可致脊髓神经功能严重损害.脊髓神经功能恢复与血肿压迫时间有直接关系.早期诊断并清除血肿压迫是挽救脊髓功能的关键.
목적 탐토흉추수술후급성경척막외혈종적형성원인、혈종압박시간대척수신경공능적영향급예방조시.방법 회고성분석2002년5월지2012년5월경수술증실적흉추후로수술후발생급성경척막외혈종치신경공능장애적14례환자자료,남6례,녀8례；년령41～69세,평균61.2세；흉추관협착증10례,흉추관내척막류3례,흉추전이류1례；흉추후로수술후3～14 h,평균6.6h,환자척수신경공능출현악화,ASIA분급A급5례,B급9례.대비혈종청제전、후이급수방시환자신경공능평분급신경공능회복솔.분석신경공능회복솔여혈종압박시간급혈종청제전신경공능적관계.결과 14례환자혈종청제후AISA분급위:B급1례,C급2례,D급4례,E급7례.기중 B、C급3례환자혈종압박시간균＞10 h.혈종청제전、후신경공능비교차이유통계학의의,혈종청제후신경공능회복솔위63.7％±23.3％,여혈종압박시간정부상관,여혈종청제전신경공능정정상관.혈종청제전신경공능여수방신경공능비교차이유통계학의의,수방신경공능회복솔위86.97％±17.58％,여혈종압박시간정부상관,여혈종청제술전신경공능정정상관.결론 흉추술후급성경척막외혈종가치척수신경공능엄중손해.척수신경공능회복여혈종압박시간유직접관계.조기진단병청제혈종압박시만구척수공능적관건.
Objective To investigate the risk factors and preventive measures for acute epidural hematoma after posterior thoracic spine surgery.Methods A retrospective study of 14 patients who developed acute epidural hematoma after thoracic spine surgery from May 2002 to May 2012 was conducted.There were 6 males and 8 females,aged from 41 to 69 years (average,61.2 years).There were 10 cases of thoracic spinal canal stenosis,3 cases of thoracic spinal meningioma,and 1 case of thoracic metastasis.About 3-14 h (average,6.6 h) after posterior thoracic spine surgery,the neurological deterioration was found,and according to the American Spinal Injury Association (ASIA) classification,there were 5 cases of grade A and 9 cases of grade B.The neurological function before evacuation of hematoma was compared with that after evacuation of hematoma and that at final follow-up.The correlations between hematoma compression time,neurological improvement rate and neurological function before evacuation of hematoma were statistically analyzed.Results After evacuation of hematoma,the ASIA classification of 14 patients was as follows:grade B in 1 case,grade C in 2 cases,grade D in 4 cases,and grade E in 7 cases.The hematoma compression time of 3 patients with grade B or C was more than 10 hours.Obvious difference of neurological function was found before and after evacuation of hematoma.The neurological improvement rate was 63.7％±23.3％ after evacuation of hematoma,which was negatively correlated with hematoma compression time and positively correlated with preoperative neurological function.The neurological function before evacuation of hematoma was significantly different from that at final follow-up.The neurological improvement rate was 86.97％±17.58％ at final follow-up,which was negatively correlated with hematoma compression time and positively correlated with preoperative neurological function.Conclusion The acute epidural hematoma after thoracic spine surgery could cause severe neurological deterioration.The neurological improvement was negatively correlated with hematoma compression time.Evacuation of hematoma must be done as soon as possible once progressive neurological deterioration is found.