脑外伤迟发性颅内血肿的临床分析

Clinical analysis of delayed cranial hematoma after cerebral trauma

目的探讨脑外伤术后非手术区迟发性颅内血肿的临床特征、形成机理及诊断治疗。方法回顾性分析40例脑外伤术后经CT扫描或再次开颅探查证实为迟发性血肿的发生部位、发生时间及其与脑挫裂伤、颅骨骨折等原发伤的关系。结果血肿部位与手术部位关系:邻近型13例、远隔型18例、对侧型9例;发生在脑内13例,硬膜外17例、硬膜下9例、脑室内1例,17例术后硬膜外血肿有12例可见颅骨骨折,13例脑内血肿12例术前CT扫描发现血肿发生部位有不同程度脑挫裂伤;血肿发生在术后24h内22例。24～72h12例、72h以上6例。结论脑外伤术后迟发性颅内血肿中,硬膜外、硬膜下与脑内血肿形成机制不尽相同,脑挫裂伤、颅骨骨折、脑膜或皮层血管破裂、桥静脉断裂等局部损伤可致不同类型的血肿,脑血管麻痹、低血氧症是非手术区迟发性血肿形成的病理基础。

Objective To explore the clinical features, mechanism, diagnosis and treatment of postoperative delayed traumatic intracranial hematoma. Methods 40 Patients of acute head injury with delayed intracranianl hematomas that occurred beyond the scope of previous operation were investigated. The relationship between the primary injuries and the intracranianl hematoma in non - operation area were retrospectively analyzed. Results Delayed intracranianl hematomas occurred near the operative area in 13 cases, far from the operative field in 18 and on the contralateral hemispherein 9. According to the frequence of the hematomas, there were exlradural hematoma in 17 eases, intraeerebral in 13, and subduran in 9, intraventrieular in]. skull fraeture was found in12/17 eases with extradural hematomas, frustrate in 12/13 cases with intracerebral hematomas, Conclusion There were different pathogenesis in the postoperative extradural, intracerebral and subdural hematomas in non- operation area. The skull fracture, brain frustrate and vessel break could distinctively play and inportance role in theose delayed hematomas. Vessel anesthesia and anoxia are the pathologic basis of the hematoma formation.