开放性颅脑损伤继发硬膜下脓肿的临床分析

Clinical analysis of secondary subdural abscess following open craniocerebral injury

目的探讨继发于开放性颅脑损伤的硬膜下脓肿的特点及治疗策略。方法对7例开放性颅脑损伤继发硬膜下脓肿病例的病因、诊断、治疗和预后进行回顾性分析。结果7例中,继发于前颅底骨折3例,中颅底骨折2例,顶骨开放性骨折2例。患者最初为发热、头痛等感染表现,进而出现颅内高压和神经系统症状。实验室检查白细胞均升高,脓液细菌培养均呈阳性。头部CT显示硬膜下有略低或混杂密度影,脓肿表层的内膜呈增强信号;MRI检查表现T1WI为中等信号或低信号,T2WI为高信号。7例均行手术治疗,其中6例行开颅脓肿清除并置管引流(5例去骨瓣,1例保骨瓣);1例行钻孔引流,随后因脓肿引流不彻底又行开颅手术并去骨瓣。经治疗后痊愈7例,并发癫痫4例。结论开放性颅脑损伤患者若出现发热、头痛,颅内高压及神经系统症状时应当考虑继发硬膜下脓肿;早期诊断及合理治疗可以明显改善患者预后。

Objective To explore the clinical features and the therapeutic strategies of the subdural abscess after open craniocerebral injury. Methods Seven cases with subdural abscess after open craniocerebral injury were retrospectively reviewed and the etiology, diagnosis and prognosis of the cases were analyzed. Results Among the seven cases ,3 cases suffered anterior basilar skull fracture ,2 cases middle basilar skull fracture ,2 cases open fracture of parietal bone. Initially,the patients showed the symptoms of local infection including fever and headache. Subsequently, the intracranial pressure was increased in all the patients accompanied with the related clinical features. The laboratory examination showed that the leukocytes increased and liquor purls culture showed positive results. The brain CT scan demonstrated that there was a low or mixed-density shadow in subdural space. The intensive CT scan showed that there was an intensive signal in the internal membrane of the surface of the abscess. MRI examination showed that T1WI represented moderate or low signal,T2WI represented intensive signal. All the patients accepted the anti-septic treatment and surgical operation,among which six cases were undergone the abscess clearance with placing the tube（5 patients were removed the bone flap whereas one was kept） and one patient accepted burr hole followed by the open craniocerebral surgery. After treatment,all the patients recovered with zero mortality. Four patients occurred epilepsy. Conclusion It should be considered subdural abscess when patients with open craniocerebral injury have the clinical features of fever,headache, increased intracranial pressure and the symptoms of central nervous systems. Early diagnosis and treatment will significantly improve the outcomes of the patients.