CAJ | 학술논문

目的：探讨腰椎减压内固定术后硬膜外血肿形成的原因、诊治及预防对策。方法2089例接受腰椎后路减压内固定手术的患者中,术后发生硬膜外血肿7例,均行急诊手术探查并清除血肿；分析其硬膜外血肿形成的原因,探讨预防对策。结果7例术后硬膜外血肿患者的首发症状均为神经功能减退,其中6例表现出下肢神经症状进行性加重,1例小便障碍。5例术后24 h内行椎管探查术,2例24~48 h内行椎管探查术。4例术前经MRI确诊有硬膜外血肿,3例未行MRI检查。术后随访1年,手术探查清除血肿越早患者神经功能恢复越好。结论硬膜外血肿的形成与多节段减压、止血材料使用不当、使用抗凝剂及止血不彻底等因素有关,术后密切观察病情、早期MRI确诊和及时的椎管探查手术,是预防和治疗术后硬膜外血肿的主要方法。
목적：탐토요추감압내고정술후경막외혈종형성적원인、진치급예방대책。방법2089례접수요추후로감압내고정수술적환자중,술후발생경막외혈종7례,균행급진수술탐사병청제혈종；분석기경막외혈종형성적원인,탐토예방대책。결과7례술후경막외혈종환자적수발증상균위신경공능감퇴,기중6례표현출하지신경증상진행성가중,1례소편장애。5례술후24 h내행추관탐사술,2례24~48 h내행추관탐사술。4례술전경MRI학진유경막외혈종,3례미행MRI검사。술후수방1년,수술탐사청제혈종월조환자신경공능회복월호。결론경막외혈종적형성여다절단감압、지혈재료사용불당、사용항응제급지혈불철저등인소유관,술후밀절관찰병정、조기MRI학진화급시적추관탐사수술,시예방화치료술후경막외혈종적주요방법。
Objective To investigate the reason,discuss its diagnosis,treatment and prevention of the spinal epidural hematoma ( SEH) following decompression and internal fixation of lumbar spine. Methods 2 089 cases with decom-pression and internal fixation of lumbar spine were enrolled. Seven cases had SEH after the primary surgery and were treated by hematoma evacuation and decompression. Preventive countermeasures of the SEH were assessed. Results Neurological deterioration was the initial symptom in 7 cases of SEH. Six cases showed lower limb progressive and se-vere neurologic deficit, one case showed urine dysfunction. Surgical exploration was performed when primary surgery was performed within 24 h in 5 cases, between 24~48 h in 2 cases. Four cases were confirmed by MRI before surgi-cal exploration, three cases were not confirmed by MRI before surgical exploration. During the follow-up of 12 months, neurological function recovery of the patient who had surgery exploration in time was better than the delayed. Conclusions These factors such as multilevel procedure, hemostatic materials improper use,using chemical antico-agulation and stanching not completely are associated with SEH. Close observation following the operation, early diag-nosis by MRI and surgery exploration performed in time are the key measures to prevent and treat SEH.