外伤性后颅窝血肿54例临床分析

Clinical analysis of 54 cases with traumatic posterior fossa hematoma

目的探讨外伤性后颅窝血肿的临床特点及救治方法。方法对该科2004年1月～2009年6月收治的外伤性后颅窝血肿54例患者的临床资料进行分析,根据外伤性后颅窝血肿的病情变化及出血量的多少而采取保守治疗或手术治疗。结果 54例患者中,保守治疗14例,恢复良好13例,死亡1例;手术治疗40例,恢复良好32例,伤残4例,死亡4例。结论创伤性后颅窝血肿有着不同于幕上创伤性颅内血肿的临床特点,意识障碍早期较轻,小脑受损的特异性症状如眼球水平震颤、共济失调等较少见,而头痛、呕吐、颈抵抗等非特异性症状较多见,易突然发生枕骨大孔疝。早期严密观察及动态CT检查,抓住手术时机,及时手术,妥善处理,可提高患者的预后,并降低死亡率。

【Objective】To investigate the clinical characteristics and treatment methods of traumatic posterior fossa hematoma.【Methods】The clinical data of 54 patients who were diagnosed as traumatic posterior fossa hematoma during January 2004 and June 2009 were reviewed.Depending on clinic conditions and the amount of bleeding,either conservative treatment or surgical treatment was given.【Results】In all the 54 patients,conservative treatment was given to 14 cases,among which 13 cases had good recovery while 1 case died.Surgical treatment was performed on 40 cases,among which 32 cases had good recovery,4 cases were disabled and 4 cases died.【Conclusion】Traumatic posterior fossa hematoma is different from the cerebral traumatic intracranial hematoma in the clinical features which has an early and slight disturbance of consciousness,rare cerebellar damage symptoms like tremor and ataxia,but more common non-specific symptoms like headache,vomiting and neck resistance,and is easy to develop into cerebellar tonsillar hernia.Early close observation,dynamic CT examination,seizing the timing of surgery,timely surgery and proper handling can improve the prognosis of patients and reduce mortality.