<div>颈椎前路椎管减压术后并发早期硬膜外血肿的临床研究</div>

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摘要目的探讨颈椎前路椎管减压术后早期硬膜外血肿形成原因、临床治疗及预防措施。方法回顾性分析海南医学院第二附属医院2010年1月至2021年12月收治并行颈椎前路椎管减压手术患者共1 685例的临床资料，所有患者均接受颈椎前路椎体次全切除减压融合术(anterior cervical corpectomy and fusion，ACCF)或颈椎前路椎间盘切除减压融合术(anterior cervical discetomy and fusion，ACDF)治疗，其中术后并发早期硬膜外血肿5例，男2例，女3例；年龄55~69岁，平均(62.40±5.27)岁；术前诊断颈椎后纵韧带骨化症2例，脊髓型颈椎病3例；术前采用美国脊髓损伤协会(American spinal injury association，ASIA)神经功能评分系统对患者神经功能进行评估。分析5例患者早期硬膜外血肿形成原因、出现时间、主要临床表现、再次手术时间对神经功能恢复的影响。结果 5例患者均获得随访，平均随访(17.20±4.32)个月。5例患者早期硬膜外血肿均发生于术后6 h内，均行急诊手术治疗。术前均行颈椎MRI检查显示血肿压迫脊髓，手术中证实为硬膜外血肿形成。5例患者手术后神经功能均恢复至术前水平或优于术前水平。结论颈椎前路椎管减压术后早期硬膜外血肿发生的高峰期在术后6 h内。早期硬膜外血肿的主要临床表现是进行性加重的神经功能损伤，诊断主要依据临床表现和颈椎MRI检查。确诊后急诊手术清除血肿是避免神经功能永久损伤的主要措施。

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	齐昊
	顾运涛
	许春召
	任善武
	赵海
	付昆

关键词 ：颈椎, 前路手术, 硬膜外血肿, 临床表现

Abstract：Objective To investigate the causes，clinical treatment and preventive measures of early epidural hematoma after anterior cervical canal decompression.
Methods We retrospectively analyzed the clinical data of 1 685 patients admitted to the Second Affiliated Hospital of Hainan Medical College from January 2010 to December 2021 who underwent concurrent anterior cervical decompression surgery.All patients were treated with anterior cervical subtotal corpectomy and decompression and fusion or anterior cervical discectomy and decompression and fusion，among which 5 cases were complicated with early epidural hematoma.2 cases were male and 3 cases were female.The patients aged 55~69 years，with an average age of (62.40±5.27) years.Two cases were diagnosed with ossification of posterior longitudinal ligament of cervical vertebra and spinal cord before operation.The causes，appearance time，main clinical manifestations and reoperation time of early epidural hematoma in 5 patients were analyzed.Results All 5 patients were followed up for an average of (17.20±4.32) months.All 5 patients with early epidural hematoma occurred within 6 hours after surgery and underwent emergency surgical treatment.Cervical magnetic resonance examination before surgery showed that the hematoma compressed the spinal cord，and the operation proved to be the formation of epidural hematoma.All 5 patients recovered to the preoperative level or better than the preoperative level.Conclusion The peak period of early epidural hematoma occurrence after anterior cervical decompression surgery is within 6 hours after surgery.The main clinical manifestation of early epidural hematoma is progressive neurological impairment，and the diagnosis is mainly based on clinical manifestations and cervical magnetic resonance examination.Emergency operation to remove hematoma after diagnosis is the main measure to avoid permanent damage to neurological function.

Key words： cervical spine anterior surgery epidural hematoma clinical manifestations

基金资助:海南省自然科学基金青年基金项目(820QN406)

通讯作者: 付昆

作者简介: 齐昊(1989－ )，男，主治医师，海南医学院第二附属医院骨科，952681706@qq.com

引用本文:

齐昊，顾运涛，许春召，任善武，赵海，付昆.

颈椎前路椎管减压术后并发早期硬膜外血肿的临床研究

[J]. 实用骨科杂志, 2023, 29(6): 481-.
Qi Hao，Gu Yuntao，Xu Chunzhao，Ren Shanwu，Zhao Hai，Fu Kun. Clinical Study of Early Epidural Hematoma After Anterior Cervical Canal Decompression. sygkzz, 2023, 29(6): 481-.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I6/481

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