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首页> 外文期刊>British journal of neurosurgery >Spinal epidural haematoma; Factors influencing outcome
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Spinal epidural haematoma; Factors influencing outcome

机译：脊髓硬膜外血肿;影响结果的因素

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Objective. Spinal epidural haematoma (SEH) causing spinal cord compression is potentially a cause of long-term neurological disability. We reviewed the relevant literature with the intention of establishing the factors that influence long-term outcome and the timeframe within which operative intervention must be undertaken for optimal results. Methods. A total of 1177 papers were identified using PubMed among which 31 papers were selected and analysed. The grades of neurological deficit, pre-and post-operatively, were classified according to the Frankel grade. The timing of surgery was from the onset of first symptoms of incomplete cord lesions and the onset of paraplegia with complete lesions. Results. The two main factors that determine long-term outcome were the degree of neurological deficit at the time of treatment and the timing of surgical intervention. Fifty-six per cent of patients who had 'incomplete SCI' made a full neurological recovery as compared to 27% when the initial injury was 'complete SCI' (Chi square, p < 0.001). Operative intervention within 12 h of onset of symptoms gave the best chance of recovery to 'normal' (Frankel E), even in patients who were paraplegic (Frankel A) pre-operatively. Conclusion. Recovery to 'normal', or 'incomplete SCI', is possible with surgical decompression if performed within 12 h, even if the patient is paraplegic pre-operatively. If the diagnosis is suspected, immediate investigations must be undertaken and/or arrangements for appropriate referral must be made urgently to ensure diagnosis and treatment in the tertiary centre within the 12 h window.
机译：目的。导致脊髓受压的脊髓硬膜外血肿（SEH）可能是长期神经系统残疾的原因。我们回顾了相关文献，目的是确定影响长期预后的因素以及为获得最佳结果而必须进行手术干预的时间范围。方法。使用PubMed总共鉴定了1177篇论文，其中选择和分析了31篇论文。手术前后神经功能缺损的等级根据Frankel等级进行分类。手术时机从脐带不全病变的首发症状和完全性病变截瘫开始。结果。决定长期结果的两个主要因素是治疗时的神经功能缺损程度和手术干预的时机。 “不完全SCI”患者中有56％的患者神经功能完全恢复，而最初损伤为“完全SCI”时为27％（卡方，p <0.001）。症状发作后12小时内进行手术干预，即使在术前处于截瘫状态（Frankel A）的患者，也能最大程度地恢复至“正常”水平（Frankel E）。结论。如果患者在术前截瘫，即使在12小时内进行手术减压，也有可能恢复到“正常”或“不完全SCI”。如果怀疑诊断，则必须立即进行调查和/或必须紧急安排适当的转诊，以确保在12小时窗口内在第三中心进行诊断和治疗。

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