脊椎手術後の症候性血腫の発生率と臨床的特徴。45 例の患者を対象とした多施設共同研究

Incidence and Clinical Features of Postoperative Symptomatic Hematoma after Spine Surgery: A Multicenter Study of 45 Patients.

• Soichiro Masuda
• Shunsuke Fujibayashi
• Mitsuru Takemoto
• Youngwoo Kim
• Bungo Otsuki
• Masato Ota
• Tsunemitsu Soeda
• Kei Watanabe
• Takeshi Sakamoto
• Naoya Tsubouchi
• Shuichi Matsuda

抄録

序章:

脊椎手術後の症候性術後血腫は稀ではあるが重篤な合併症である。本研究の目的は、脊椎手術後の症候性術後血腫の発生率と臨床的特徴を調査することであった。

Introduction: Symptomatic postoperative hematoma after spine surgery is a rare but serious complication. The objective of this study was to investigate the incidence and clinical features of symptomatic postoperative hematoma after spine surgery.

方法:

2002年から2012年の間に9病院で脊椎手術を受けた10,680例をレトロスペクティブに同定した。術後血腫の発生率とその臨床的特徴（発症前の時間、主な症状、神経学的転帰を含む）を検討した。

Methods: We retrospectively identified 10,680 patients who underwent spine surgery between 2002 and 2012 in nine hospitals. We reviewed the incidence of postoperative hematoma and its clinical features, including time before onset, main symptoms, and neurological outcomes.

結果:

脊椎手術後の症候性術後血腫の全発生率は0.4％（45/10,680例）であった。術後血腫は頸椎・腰椎手術後よりも胸椎手術後の方が多かった。術後血腫の発症は術後平均2.6日（範囲0～14日）であった。脊椎手術後の術後血腫による主な症状は、四肢麻痺30例、片麻痺8例、難治性疼痛5例、気道機能障害2例であった。脊椎硬膜外血腫を外科的に退避させた結果，35例で1グレード以上の改善がみられたが，退避手術後も完全な運動麻痺がみられたのは4例であった。

Results: The overall incidence of symptomatic postoperative hematoma after spine surgery was 0.4% (45/10,680). Postoperative hematoma was more frequent after thoracic spine surgery than after cervical or lumbar surgery. The onset of postoperative hematoma occurred at an average of 2.6 days (range 0-14 days) postoperatively. The chief symptoms caused by postoperative hematoma after spine surgery were tetra/paraplegia in 30 patients, hemiplegia in eight patients, intractable pain in five patients, and airway dysfunction in two patients. Surgical evacuation of the spinal epidural hematoma resulted in improvement of at least one grade in 35 patients, while four patients had complete motor paralysis even after evacuation surgery.

結論:

脊椎手術後に症候性血腫を発症した45例の臨床的特徴を報告する。この情報は、外科医が脊椎手術後の術後血腫の迅速な診断と早期退院手術を行う際に役立つ可能性がある。

Conclusions: We report the clinical details of 45 patients with postoperative hematoma after spine surgery. This information could assist surgeons to make a prompt diagnosis and perform early evacuation surgery for postoperative hematoma following spine surgery.

Copyright © 2020 by The Japanese Society for Spine Surgery and Related Research.