外伤性双侧硬脑膜外血肿(附30例报告)

Traumatic bilateral epidural hematomas:report of 30 cases

目的总结外伤性双侧硬脑膜外血肿(TBEDH)的临床特点和早期诊治办法。方法对30例TBEDH的临床特点、影像学检查结果、治疗方法和结果进行回顾性总结。结果30例中24例血肿位于中线旁,6例血肿位于中线两侧不同部位。14例伤后首次CT扫描明确诊断,16例表观为进展性,经手术或再次CT扫描确诊。30例均行手术清除血肿,27例为静脉性出血。出院时根据GOS评分恢复良好25例,中残3例,重残1例,死亡1例。结论TBEDH多见于前后方向着力者,多为静脉性出血；早期诊断和处理与预后密切相关。

Objective To summarize the clinical features of traumatic bilateral epidural hematomas （TBEDH） and the experience of diagnosis and treatment on such patients. Methods The clinical manifestations, neuroradiological findings, therapeutic methods and outcomes of 30 TBEDH cases were reviewed retrospectively. Results Among the 30 cases, hematomas were in either side of midline in 24 cases, and at different sides of midline in 6 cases. Hematomas in 14 cases were confirmed on initial CT scanning, and the other 16 cases were progressive which were confirmed by operation or repeated CT scanning. All hematomas were evacuated after diagnosis, and venous bleeding was confirmed in 27 cases, According to GOS, 25 cases recovered well, 3 cases became moderately disabled, 1 case was severely disabled and 1 case died. Conclusion Majority of TBEDH were caused by anteroposterior forces and mainly due to venous bleeding. Early diagnosis and management were directly related to its prognosis.