【摘要】 目的探讨椎管内自发性出血的病因、诱因、临床表现、影像学特点、治疗及影响预后的相关因素。方法回顾性分析2001年2月至2010年1月收治的34例椎管内自发性出血患者的临床资料。34例患者中保守治疗4例,手术治疗30例。手术前后神经功能状态通过日本骨科学会(JOA)评分进行评估,同时对影响预后的因素进行分析。结果椎管内出血量为0.5~10ml。此34例病例中,动静脉畸形14例,海绵状血管瘤5例,脊膜瘤1例,恶性黑色素细胞瘤1例,非朗格汉斯组织细胞增生症1例,原因不明的椎管内出血12例。术前JOA评分为(3.26±2.97)分,术后为(10.98±4.23)分,两者相比较,相差显著(P<0.05);17例不完全性运动障碍患者的手术前后JOA评分分别为(6.05±2.86)分和(13.59±3.41)分,两者相比较,差异显著(P<0.05)。结论胸腹腔压力突然增高是椎管内自发性出血的一个重要诱因。患者的预后与病因及术前神经功能障碍程度有关,并提示从发病到手术的时间间隔可能也是影响椎管内自发性出血患者预后的一个因素。更多还原

【Abstract】 Objective To explore the causes, inducement, clinical manifestations, imaging features, treatments, and factors related to prognosis in the patients with spontaneous intraspinal hemorrhage. Methods The clinical data of 34 patients with spontaneous intraspinal hemorrhage treated in our hospital from February, 2001 to January, 2010 were analyzed retrospectively. The function of the spinal cord was assessed by Japan Orthopedic Association Scale (JOAS) before and after the treatment. The factors influencing the prognosis were analyzed. Results The hematoma volume ranged from o.5 to 10 ml in these 34 patients with spontaneous intraspinal hemorrhage, of whom, 30 were treated surgically and 4 conservatively. The pathological examination showed that, of 34 patients, 14 suffered from arteriovenous malformations, 5 from cavernous angiomas, 1 from meningioma, 1 from malignant melanoma, 1 from non-Langerhans histiocytosis, and 12 had intracranial hematomas which were produced by the undefined causes. The score of JAOS [(10.98±4.23) scores] was significantly higher after the operation than that [(3.26±2.97) scores] before the operation (P<0.05). The score of JAOS [(13.59±3.41) scores] was significantly higher after the operation than that [(6.05±2.86) scores] before the operation in 17 patient with incomplete movement disorders (P<0.05). Conclusions The sudden increase in the intrathoracic and intraperitoneal pressures is the important inducement of the spontaneous intraspinal hemorrhage. The prognoses in the patients with spontaneous intraspinal hemorrhage are directly related to the pathogenicity of the hemorrhage, gravity of the neuronal function disorder before the operations, and it is suggested that the interval between the hemorrhage and the operation may be also related to the prognosis in the patients with spontaneous intraspinal hemorrhage.更多还原