本文選題：血腫　切入點(diǎn)：硬膜外　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:探討自發(fā)性脊髓硬膜外血腫(SSEH)患者的治療策略及神經(jīng)功能預(yù)后影響因素。方法:回顧性納入2004年6月-2016年3月天津醫(yī)科大學(xué)總醫(yī)院收治的42例SSEH患者,其中手術(shù)組24例,保守治療組18例。分別采用日本骨科協(xié)會(huì)(JOA)脊髓功能評(píng)分表(簡(jiǎn)稱(chēng)JOA評(píng)分)和美國(guó)脊髓損傷協(xié)會(huì)(ASIA)脊髓損傷分級(jí)(簡(jiǎn)稱(chēng)ASIA分級(jí))對(duì)患者進(jìn)行神經(jīng)功能狀況的評(píng)估,依據(jù)治療前、治療后JOA評(píng)分,評(píng)估患者治療后的神經(jīng)功能恢復(fù)率。根據(jù)ASIA分級(jí)分組,對(duì)于手術(shù)及保守治療患者,比較各組的神經(jīng)功能恢復(fù)率;相同ASIA分級(jí)比較手術(shù)組和保守治療組對(duì)于神經(jīng)功能恢復(fù)率有無(wú)影響。手術(shù)患者依據(jù)發(fā)病至手術(shù)的時(shí)間間隔,分為12h組、12~24h組和≥24h組,比較各組神經(jīng)功能恢復(fù)率。根據(jù)患者年齡、性別、血腫長(zhǎng)度、血腫對(duì)脊髓壓迫程度、血腫所在椎體水平進(jìn)行分組,統(tǒng)計(jì)各因素與神經(jīng)功能恢復(fù)率的關(guān)系。隨訪(fǎng)時(shí)間為4~34個(gè)月,平均(18±6)個(gè)月。結(jié)果:根據(jù)ASIA分級(jí)分組,手術(shù)患者比較各組神經(jīng)功能恢復(fù)率,差異有統(tǒng)計(jì)學(xué)意義(F=11.76,p0.01);保守治療患者比較各組神經(jīng)功能恢復(fù)率,差異有統(tǒng)計(jì)學(xué)意義(F=20.25,p0.01)。相同ASIA分級(jí)中手術(shù)組和保守組進(jìn)行比較。ASIA同為C級(jí)的手術(shù)組與保守組間神經(jīng)功能恢復(fù)率差異有統(tǒng)計(jì)學(xué)意(t=2.34,p0.05)。ASIA同為D級(jí)的手術(shù)組與保守組間神經(jīng)功能恢復(fù)率差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.43,p0.05)。比較12h組、12~24h組和≥24h組,術(shù)后神經(jīng)功能恢復(fù)率,差異有統(tǒng)計(jì)學(xué)意義(F=11.40,P0.01)。性別、年齡、血腫長(zhǎng)度對(duì)于神經(jīng)功能恢復(fù)率無(wú)明顯線(xiàn)性相關(guān)性(p0.05),血腫對(duì)脊髓壓迫程度對(duì)于神經(jīng)功能恢復(fù)率呈負(fù)相關(guān)性(p0.05,r=-0.45)。按照血腫在椎體水平的位置進(jìn)行分組,腰段數(shù)據(jù)不具有統(tǒng)計(jì)學(xué)意義,對(duì)于頸段、頸胸段、胸段、胸腰段四組進(jìn)行統(tǒng)計(jì)學(xué)分析,差異無(wú)統(tǒng)計(jì)學(xué)意義(F=2.55,p0.05)。結(jié)論:對(duì)于ASIA分級(jí)為A、B、C級(jí)或神經(jīng)功能障礙進(jìn)行性加重的患者,盡早手術(shù)治療可獲得良好預(yù)后;對(duì)于ASIA分級(jí)為D或E級(jí),或短期內(nèi)神經(jīng)功能有好轉(zhuǎn)趨勢(shì)的患者,可選擇保守治療亦可取得良好預(yù)后。影像學(xué)上血腫對(duì)脊髓壓迫程度也是手術(shù)及預(yù)后重要參考因素。手術(shù)患者的預(yù)后與術(shù)前ASIA分級(jí)、發(fā)病至手術(shù)的時(shí)間間隔相關(guān)。術(shù)前ASIA分級(jí)越高,發(fā)病至手術(shù)的時(shí)間間隔越短,是良好預(yù)后的保證。保守患者預(yù)后與治療前ASIA分級(jí)相關(guān)。治療前ASIA分級(jí)越高,預(yù)后越好。
[Abstract]:Objective: to investigate the therapeutic strategies and prognostic factors of neurologic function in patients with spontaneous spinal epidural hematoma (SSEH). Methods: 42 patients with SSEH were treated in Tianjin Medical University General Hospital from June 2004 to March 2016. In the conservative treatment group, 18 patients were assessed with the spinal cord function scale (JOA) of Japan Orthopedic Association (JOAA) and the American Spinal Cord injury Association (ASIA). After treatment, JOA score was used to evaluate the recovery rate of nerve function after treatment. According to the ASIA classification, the recovery rate of nerve function was compared between the operation group and the conservative treatment group. According to the time interval from onset to operation, the patients were divided into 12h group (12h group) and 12h group (鈮，

本文編號(hào)：1647288