颅脑创伤急性期双侧硬膜外血肿的诊断及治疗

Diagnosis and treatment of bilateral epidural hematoma in acute phase of craniocerebral trauma

目的观察急性外伤性双侧硬膜外血肿的临床、影像特点,以探讨其形成机制,并分析其临床诊断及治疗要点。方法对我院治疗的14例(男性11例,女性3例)急性外伤性双侧硬膜外血肿患者的临床、影像资料及预后进行回顾性分析。结果本研究中急性双侧硬膜外血肿常见的有3种情况:中线部位跨矢状窦血肿(5例),双侧对冲部位血肿(6例)以及一侧硬膜外血肿术后对侧迟发血肿(3例),均于伤后48 h内诊断。患者入院时GCS 13～15分8例,9～12分1例,≤8分5例。手术治疗9例,其中一次手术7例,二次手术2例;保守治疗5例。除2例死亡,1例植物生存外,余病人恢复良好。结论头颅平片对预测急性双侧硬膜外血肿有重要意义,动态CT扫描是及时发现血肿并观察其变化的重要手段:双侧硬膜外血肿早期发现并及时手术者大多预后良好。

Objective To identify the clinical manifestations, imaging features and mechanisms of acute traumatic bilateral epidural hematomas （EDHs）, so as to provide evidences for the diagnosis and treatment of EDHs, Methods This report involved 14 cases （11 males and 3 females） of bilateral EDHs hospitalized between Apr., 2002 and Oct., 2005. Clinical, radiological data and prognosis of the 14 cases were retrospectively analyzed. The neurological evaluations on admission and during hospital stay were based on the Glasgow Coma Scale. Hematomas were determined and observed by dynamic CT scans. Two patients had MRI scans. The patients were evaluated using the Glasgow Outcome Scale during follow-up. Results The three conditions frequently seen in acute bilateral EDHs could be classified as 3 groups, hematomas across sagittal sinus（n=5）, in two sides of midline（n=6） or delayed EDHs contralateral to primary EDHs（n=3）. All bilateral EDHs were diagnosed within 48 h. Eight patients were admitted with GCS 13-15, 1 patient with 9-12 and 5 with ≤8. Surgical treatment was performed on 9 cases, once in 7 cases and twice in 2 cases; conservative treatment was performed on 5. The mortality rate was 14% （2/14）; vegetative status occurred in 1 case; the other patients recovered well. Conclusion Skull X-ray should be an important prediction technique for acute bilateral EDHs. Dynamic CT scans played a very important role in detecting and observing this rare condition. For these patients, early diagnosis and treatment are critical for achieving good outcomes.