小儿严重外伤性硬脑膜静脉窦损伤19例

The severe sinus injury in children.

目的探讨小儿严重硬脑膜静脉窦损伤的治疗方法。方法回顾性分析19例小儿严重硬脑膜外伤性静脉窦损伤的诊治经过。19例中,采取上矢状窦结扎4例,上矢状窦修补14例,人造血管静脉窦重建1例。在处理静脉窦损伤的同时行颅内血肿清除及颅骨凹陷骨折复位术,其中7例开放性损伤患儿均行颅骨片一期植入术。结果全组痊愈14例(73.6%),肢体瘫痪2例(10.5%),死亡3例(15.7%)。术中平均失血量500 ml(200～4000 ml),其中8例出现失血性休克。3例死亡患儿均因术中严重失血导致不可逆性休克而死亡。结论小儿严重硬脑膜静脉窦损伤伤情重,处理困难,术中死亡率高。术前应根据颅骨骨折类型、部位及程度对静脉窦损伤作出诊断,充分准备,快速控制大出血,果断采取不同的止血及修补措施,以达到止血及恢复静脉窦通畅的目的。

Objective To improve the level of diagnosis and treatment of severe sinus injury in children. Methods A retrospective chart reviewwas performed on 19 cases of children with severe sinus injury. Results 14 cases were recovered, mild physically paralysis in 2 cases, 3 deaths. Conclusions It is handling difficulties and high mortality that children with serious injury of intracranial venous sinus. Preoperative prepare should fully understand the skull fracture type, location and extent of damage to the sinus, satisfaction exposure and control bleeding rapidly during the operation, decisively taken different measures to stop bleeding and repair to achieve hemostasis and restore sinus patent purposes.