单纯性急性外伤性硬膜下血肿63例治疗分析

Study on the therapy of acute simple traumatic subdural hematomas: 63 cases report

目的探讨单纯性急性外伤性硬膜下血肿的治疗特点。方法本组共63例,急诊手术25例,保守治疗38例(其中有9例保守治疗失败后中转手术)。手术方式:小骨窗开颅24例,颞肌下减压7例,标准外伤大骨瓣开颅3例;术前根据受伤机制、临床表现、CT资料等初步确定出血位置及性质。结果按3月后GOS评分,良好46例(73.02%),中残8例(12.70%),重残0例(0%),植物生存1例(1.59%),死亡2例(3.17%)。结论单纯性硬膜下血肿保守治疗指征可适当放宽,手术方式首选小骨窗开颅,可减少创伤,加快病人康复。

Objective To summarize the therapeutic characters of acute simple traumatic subdural hematomas. Methods 63 patients with acutie simple traumatic subdural hematomas were reviewed. Emergency operations were performed in 25 cases. The other patients accepted the expectant treatment （9 cases were transferred to surgical operation during the conservative treatment）. The operation methods included： small bone window craniotomy in 24 cases, subtemporal decompression in 7 cases and large standard traumatic bone flap craniotomy in 3 cases. Before the operation, the positions and peculiarity of intracalvarium bleeding were primarily determined according to the injury mechanism, clinical manifestation and computerized tomography image and so on. Results All patients were evaluated according to Glasgow Outcome Scale after 3 months follow-up. 46 patients recovered well （73.02 % ）, 8 patients were moderately disabled （12.70%）, no patient was severely disabled （0 % ）, one patients was under vegetative state （ 1.59 % ）, and 2 patients died （3.17 % ） . Conclusion The indication of conservative treatment for simple traumatic subdural hematomas could be given to more patients. Small bone window craniotomy is the better operation method, it can decrease the operation insults and facilitate the patient＇s recovery.