摘要：
目的 探讨自发性椎管内硬膜外、硬膜下血肿的病因、临床特点、诊断、治疗及预后.方法 回顾性分析新疆医科大学第一附属医院神经外科自2013年9月至2016年1月收治的10例自发性椎管内硬膜外血肿及4例自发性椎管内硬膜下血肿患者的临床资料,其中12例行手术治疗、2例行保守治疗,并根据美国脊髓损伤协会损伤分级(ASIA)对患者治疗前后的神经功能进行评估. 结果 自发性椎管内硬膜外及硬膜下血肿好发于青年,多急性起病,且硬膜外血肿较硬膜下血肿更为常见.14例患者中动静脉畸形1例,髓周动静脉瘘1例,原因不明的椎管内出血12例.术前ASIA分级A级5例,B级2例,C级4例,D级3例;术后ASIA分级A级4例,C级1例,D级3例,E级4例;另2例保守治疗患者神经功能恢复至正常(E级). 结论 椎管内出血一经确诊,应考虑立即行手术治疗.患者术前神经功能越好预后越佳,发病到手术的时间间隔越短预后越好.%Objective To explore the etiology,clinical manifestations,diagnoses,treatments and prognoses of spontaneous spinal epidural and subdural hematomas.Methods Medical records of 10 patients with spontaneous spinal epidural hemorrhage and 4 patients with subdural hemorrhage,collected in our hospital from September 2013 to January 2016,were analyzed retrospectively.Evacuation of the hematoma was carried out in 12 patients and the other two patients were treated conservatively.The functions of spinal cords were assessed by American Spinal Injury Association impairment scale (ASIA) before and after the treatment.Results Spontaneous spinal epidural and subdural hematomas appeared mostly in young patients with sudden onset.Spinal epidural hematomas were much more common than subdural ones.The pathological examination showed that one suffered from arteriovenous malformation,one suffered from perimedually artriovenous fistula,and 12 had intracranial hematomas which were resulted from undefined causes.The ASIA before the operation was as follows:5 were in grade A,2 in grade B,4 in grade C and 3 in grade D.The ASIA after the operation was as follows:4 were in grade A,one in grade C,3 in grade D and 4 in grade E.The two patients received conservative treatments achieved total recovery of the neurological functions (grade E).Conclusions It should be stressed that early diagnosis and prompt surgical intervention are of great importance for prompt of spontaneous spinal epidural.The better the preoperative neurological status,the better the neurological outcome after the surgical operation.
