纵裂分离型硬膜下积液的临床研究

Clinical study of separate interhemispheric subdural effusion

目的提出纵裂分离型硬膜下积液的概念，进一步研究本病的发生机制、诊断、治疗和预防。方法回顾性对比544例颅脑损伤患者经过大骨瓣开颅减压术（治疗组）或非大骨瓣开颅减压术（对照组），单侧开颅或双侧开颅治疗后纵裂分离型硬膜下积液的发生率，分析其发生机制和可能的相关因素。结果治疗组中CT示38例发生纵裂分离型硬膜下积液，其中行单侧大骨瓣减压14例，双侧大骨瓣减压24例：对照组中CT示8例发生纵裂分离型硬膜下积液，其中行单侧弃骨瓣减压手术2例，双侧弃骨瓣减压手术6例。治疗组与对照组纵裂分离型硬膜下积液发生率差异有统计学意义（X2=9．758，P=0．002），但两组中单侧开颅或双侧开颅的发生率差异没有统计学意义（x2=0．053，P=0．818）。结论纵裂分离型硬膜下积液属于硬膜下积液的一种类型，与大骨瓣开颅术后脑组织移位有着重要的关系，是大骨瓣开颅术后的常见并发症之一；利用影像学手段能方便的对其作出诊断，及早发现、及早治疗能取得良好的治疗效果，尽量减少骨窗的大小和术后脑组织移位是最好的预防措施。

Objective To propose the concept of separate interhemispheric subdural effusion, and further study the pathogenesis, diagnosis, treatment and prevention of the disease. Methods 544 patients with head injury who were treated by decompressive craniotomy with large bone flap removal （treatment group） or decompressive craniotomy without large bone flap removal （control group） were retrospectively analyzed for understanding the incidence of separate interhemispheric subdural effusion and studying the pathogenesis and risk factors of the disease. Results CT examination showed separate interhemispheric subdural effusion occurred in 38 cases, including 14 of unilateral craniotomy and 24 of bilateral craniotomy, in the treatment group, and 8 cases, including 2 of unilateral craniotomy with disposable bone flap and 6 of bilateral craniotomy with disposable flap, in the control group. The difference in the incidence of separate interhemispheric subdural effusion was significant statistically between treatment and control groups （X2=9.758,P=0.002）, but not significant between unilateral and bilateral craniotomies in the two groups （X2 =0.053,P =0.818）. Conclusions Separate interhemispheric subdural effusion is one type of subdural effusion, and related to brain tissue shift after large bone flap craniotomy. It is one of the most common complications after the craniotomy. It can be diagnosed conveniently by the means of imaging. Early diagnosis and treatment will be beneficial for good prognosis, and to reduce the size of the bone window and to avoid brain tissue shift after operation are the best preventive measures.