摘要目的 探讨颈椎前路手术后早发性硬膜外血肿的早期诊断及治疗方法.方法 1984年6月至2014年5月行颈椎前路手术的3 117例病例中发生早发性硬膜外血肿7例,均发生于术后6～8 h.颈椎前路椎体次全切减压融合术(anterior cervical corpectomy and fusion,ACCF)术后6例,颈椎前路椎间盘切除减压融合术(anterior cervical discectomy and fusion,ACDF)术后1例.对7例出现硬膜外血肿患者进行年龄、身高、体重、术前非甾体抗炎药物应用史、术式、出血量及术中止血措施、血肿发生的时间和清除血肿的时间等进行分析.MR检查确诊血肿后结合患者的临床表现决定是否手术治疗.对血肿导致的神经功能障碍进行ASIA分级,血肿确诊时间与确诊时ASIA分级的关系,血肿确诊至手术时间与随访1年ASIA分级的关系,采用Spearman分析方法进行相关性分析.结果 7例发生术后早发性硬膜外血肿,占0.22％.7例患者中年龄超过60岁6例,占86％;超过70岁3例,占43％.5例为肥胖,占71％.6例(86％)为ACCF手术,占所有AC-CF病例的0.42％(6/1416);1例(14％)ACDF手术,占所有ACDF病例的0.06％(1/1573).7例患者初次手术中均行减压节段后纵韧带切除.7例患者MR检查均证实血肿存在,但1例患者MR检查后临床症状缓解,故未即刻行血肿清除术,观察过程中症状持续好转,术后1年ASIA分级恢复到E级;6例即刻行血肿清除术,5例术后1年ASIA分级均有1级以上的提升,1例(14.3％)血肿确诊时D级,行血肿清除术后1年仍为D级.单因素及多因素分析结果显示高龄是早发性硬膜外血肿的高危因素.Spearman分析结果显示血肿确诊时间与确诊时ASIA分级无明显相关关系,血肿确诊至再手术时间与随访1年ASIA分级无明显相关关系.结论 颈椎前路术后6～8 h内是早发性硬膜外血肿发生的高峰,根据早发性硬膜外血肿特有的临床表现和颈椎MR检查能早期诊断.对于脊髓压迫严重者,确诊后早期再次手术清除血肿对神经功能恢复至关重要.

abstractsObjective To investigate the early diagnosis and treatment of early postoperative epidural hematoma after anterior cervical spine surgery.Methods There were 3 117 cases of anterior cervical spine surgery from June 1984 to May 2015.There were 7 cases of early onset of epidural hematoma,including 6 cases of ACCF,3 cases of autogenous iliac bone graft,3 cases of titanium mesh bone graft,and 1 cases of ACDF.We analyzed 7 cases of early postoperative epidural hematoma after anterior cervical ACDF and ACCF surgery in terms of age,height,weight,application of NSAIDs,the type of surgery,bleeding volume,measures of stopping bleeding,hematoma occurring time and time of removing hematoma.Surgical decision was made after MRI examination and clear evidence of clinical manifestations.Analysis of the re-operative cases was done.ASIA grading in hematoma causes was graded.The relations of the hematoma diagnosed time and classification of ASIA were studied.Relationships of confirmed time and operation time interval and ASIA grade of 1 year follow-up were studied.The spearman analysis was used.Results There were 7 cases of early postoperative epidural hematoma,accounting for 0.22％ of the total cases.6 cases of patients were in the age of more than 60 years old,accounting for 86％;3 cases were more than 70 years old,accounting for 43％.5 cases were obesity,accounting for 71％.There were 6 cases of ACCF in this group accounting for 86％ of the cases of hematoma,which was 0.42％ (6/1 416) of all ACCF cases.There was 1 case of ACDF accounting for 14％ of the cases of hematoma,and 0.06％ (1/1 573) cases of ACDF.Posterior longitudinal ligament were all removed in 7 cases in the first operation.The existence of hematoma was confirmed in 7 cases while 1 case's clinical symptoms was relieved after MRI examination and did not perform a second operation.The symptoms were improved for this case,and the ASIA level was E level in 1 year.6 cases underwent imnediate evacuation of hematoma,5 cases had more than one ASIA grade improvement 1 year after operation.One case (14.3％) was grade D at the time of hematoma and at 1 year follow-up.Using Spearman,it can be concluded that there was no significant correlation between the time of diagnosis and the ASIA classification.The relationship of the interval time between diagnosis confirmed and operative time and ASIA grade of 1 year follow-up was analyzed using Spearman analysis,it can be concluded that the interval and ASIA grade at one year follow-up had no significant correlation.Conclusion Early onset epidural hematoma occurred in 6 to 8h after anterior cervical spine surgery.According to the specific clinical manifestations of early onset epidural hematoma and cervical MRI examination,we can make an early diagnose.For serious spinal cord compression,once the diagnosis is confirmed,early surgery of removing the hematoma is needed.