Operative treatment of spontaneous spinal epidural hematomas: A study of the factors determining postoperative outcome
Operative treatment of spontaneous spinal epidural hematomas: A study of the factors determining postoperative outcome
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DOI：
10.1097/00006123-199609000-00012
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发表时间：
1996-09-01
期刊：
影响因子：
4.8
通讯作者：
vanAlphen, HAM
中科院分区：
文献类型：
--
作者：
Groen, RJM;vanAlphen, HAM
目的：我们澄清的因素影响术后结果的患者患有自发性脊髓硬膜外hematomas.METHODS：我们回顾了330例自发性脊髓硬膜外血肿从国际文献和我们自己的3个未发表的情况下。注意力集中在性别，年龄，病史，死亡率，血肿的大小和位置，血肿的椎体水平，术前神经系统状况，手术间隔时间和术后结果。结果：性别，年龄，血肿的大小和位置与术后结果无关。死亡率与颈部或颈胸血肿高度相关，特别是在心血管疾病患者和接受抗凝治疗的患者中。不完全术前感觉运动缺陷与良好结局高度相关（P <0.0005），感觉运动功能完全丧失的患者，减压时间小于或等于36小时时恢复明显更好不完全性感觉运动功能障碍患者在≤ 48h内恢复正常（P <0.05）结论：术前神经功能缺损程度和手术时间是影响自发性硬膜外血肿术后恢复的关键因素。血肿的椎体水平与术后结果无关，这表明局部压迫，而不是血管阻塞，是产生神经功能缺损的主要因素。
OBJECTIVE: We clarify the factors affecting postoperative outcomes in patients who have suffered spontaneous spinal epidural hematomas.METHODS: We review 330 cases of spontaneous spinal epidural hematomas from the international literature and three unpublished cases of our own. Attention was focused on sex, age, medical history, mortality, size and position of the hematoma, vertebral level of the hematoma, preoperative neurological condition, operative interval, and postoperative result.RESULTS: Sex, age, and size and position of the hematoma did not correlate with postoperative outcome. Mortality correlated highly with cervical or cervicothoracic hematomas, especially in patients with cardiovascular disease and those undergoing anticoagulant therapy. Incomplete preoperative sensorimotor deficit correlated highly with favorable outcomes (P < 0.0005), and recovery was significantly better when decompression was performed in less than or equal to 36 hours in patients with complete sensorimotor loss (P < 0.05) and in less than or equal to 48 hours in patients with incomplete sensorimotor deficit (P < 0.005).CONCLUSION: The critical factors for recovery after spontaneous spinal epidural hematoma are the level of preoperative neurological deficit and the operative interval. The vertebral level of the hematoma did not correlate with postoperative results, which suggests that local compression, rather than vascular obstruction, is the main factor in producing neurological deficit.