外伤性帽状腱膜下血肿合并眶内血肿的治疗

The treatment of the subgaleal hematoma combined with intraorbital hematoma

目的 探讨头部外伤性帽状腱膜下血肿合并眶内血肿的治疗方法。方法 以B超和CT确定诊断。首先穿刺抽出帽状腱膜下血肿 ,加压包扎 ,然后再抽出眶内血肿。如血液凝结而抽不出凝血时 ,则向眶内血肿处注入尿激酶使凝血溶解。为防止眶内血肿复发 ,于抽出帽状腱膜下血肿后 ,在眉弓处放置纱布条或海绵条后加压包扎。结果 8例 9眼的眼位和眼球运动均恢复正常。 7眼术后视力≥ 1 0 ,其余 2眼为 0 4和 0 5。结论 帽状腱膜下血肿合并眶内血肿易由临床影像学确定诊断。治疗应首先抽出头部帽状腱膜下的血肿 ,加压包扎 ,再抽出眶内血肿。及时治疗 ,视力结果良好。

Objective To investigate the treatment of the subgaleal hematoma combined with intraorbital hematoma.Methods The diagnosis was made chiefly with B scan and CT. The subgaleal hema toma was aspirated first, and compressive bandaging was applied on the scalp. Then the intraorbital hematoma was aspirated. If the blood had been coagulated and difficult to be aspirated, urokinase may be injected into the hematoma to dissolve the clot. For preventing recurrence of the intraorbital hematoma after aspiration, a piece of sponge may be put at the supracilliary riges and compressive bandaging was applied over it. Results All of the nine eyes of the eight cases returned to their normalpositions. The visual acuity had improved to ≥1.0 in seven eyes, to 0.4 and 0.5 in another 2 eyes.The movement of the extraocular muscles of all the 9 eyes had returned to normal.Conclusion The diagnosis of the subgaleal hematoma combined with intraorbital hematoma was easily diagnosed with B scan and CT. In the management, the subgaleal hematoma should be aspirated first, then the intraorbital hemamatoma.The prognosis for vision is good with early treatment.