Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture.
Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture.
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DOI：
10.1155/2016/6295817
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发表时间：
2016
影响因子：
--
通讯作者：
Takaso M
中科院分区：
文献类型：
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作者：
Minato T;Miyagi M;Saito W;Shoji S;Nakazawa T;Inoue G;Imura T;Minehara H;Matsuura T;Kawamura T;Namba T;Takahira N;Takaso M
我们报告一例胸腰椎后路融合术后发生脊髓硬膜外血肿（SEH）的罕见病例。一名42岁的男子因背部被夹在破碎的混凝土块上而导致胸椎骨折而住院。计算机断层扫描显示AO B2型T12脱位骨折、多处双侧肋骨骨折和右侧血气胸。损伤后4天，为了促进早期体位稳定和改善呼吸状态，我们进行了胸腰椎后路融合手术，未减压;患者出现背痛，但无神经功能缺损。术后3小时，患者主诉双侧下肢剧痛和严重无力;脐水平以下的异常性疼痛，诊断为术后SEH。我们立即进行了翻修手术。血肿清除后，他的症状逐渐改善，并在翻修手术后1个月出院。根据本病例的经验，我们应在术前强烈考虑既存SEH的可能性，即使患者没有神经功能缺损。我们还应该考虑多发性创伤患者的围手术期凝血功能障碍，如本例。
We present a rare case of spinal epidural hematoma (SEH) after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case.