颈前路术后致脊髓硬膜外血肿的因素分析
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1.河南中医药大学第二临床医学院;2.郑州人民医院;3.郑州市骨科医院;4.河南省骨科医院

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Analysis of Factors Causing Spinal Epidural Hematoma After Anterior Cervical Surgery
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1.Second College of Clinical Medicine, Henan University of Traditional Chinese Medicine;2.Zhengzhou people'3.'4.s hospital;5.Zhengzhou Orthopaedic Hospital;6.Henan Provincial Orthopaedic Hospital

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    摘要:

    目的 分析颈前路术后致脊髓硬膜外血肿的临床表现、相关因素、治疗及预防。方法 回顾分析2015年1月至2022年1月行颈椎前路减压内固定术手术后致脊髓硬膜外血肿4例(脊髓型颈椎病4例),分析该4例患者出现脊髓硬膜外血肿的临床表现、相关因素、治疗及预后。结果 1例于血肿探查清除术后10天死亡。末次随访时,2例患者ASIA分级由B级恢复至E级,1例患者ASIA分级由A级恢复至D级。讨论 颈前路手术后致硬膜外血肿的相关因素主要为患者既往有凝血功能异常、术中止血不彻底、后纵韧带切除、术后引流异常等。当患者出现神经症状时,及时行血肿探查清除术。为预防颈前路手术后出现硬膜外血肿,在术前应详询患者有无凝血性疾病、术中应操作精细并及时精确止血、术后应密切关注患者生命体征。

    Abstract:

    Objective To analyze the clinical manifestations, related factors, treatment and prevention of epidural hematomas caused by anterior cervical surgery. Methods From January 2015 to January 2022, 4 cases of epidural hematomas (4 cases of spinal cervical spondylosis) caused by anterior cervical internal fixation surgery were retrospectively analyzed, and the clinical manifestations, related factors, treatment and prognosis of spinal epidural hematomas in these four patients were analyzed. Results One patient died 10 days after hematoma detection and removal. At the last follow-up, the ASIA rating of 2 patients was restored from B grade to E, and the ASIA grade of 1 patient was restored from A grade to D.Discussion The factors related to epidural hematoma after anterior cervical surgery are mainly the patient""s previous coagulation dysfunction, incomplete intraoperative hemostasis, posterior longitudinal ligament resection, and postoperative drainage abnormalities. When the patient develops neurological symptoms, prompt hematoma detection and removal is performed. In order to prevent epidural hematoma after anterior cervical surgery, patients should be consulted in detail before surgery for coagulation disease, fine operations should be performed during surgery and timely and precise hemostasis should be performed, and patients should pay close attention to vital signs after surgery.

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  • 收稿日期:2022-09-19
  • 最后修改日期:2022-09-19
  • 录用日期:2022-11-07
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