后枕部硬脑膜外血肿CT分型与疗效、预后的关系

Relationship between CT classification of traumatic posterior occipital epidural hematomas and both its curative effect and prognosis

目的 根据外伤性后枕部硬脑膜外血肿（POEH）的CT表现进行分型,并分析分型与疗效、预后间的关系.方法 对104例POEH患者以横窦为中心进行CT分型,其中Ⅰ型为横窦上型,Ⅱ型为横窦下型,Ⅲ型为骑跨型.上述3型进一步分为单、双侧.单侧血肿采取一侧旁正中入路骨瓣或骨窗开颅血肿清除术,双侧血肿采取枕部中线骨瓣入路开颅术.结果 Ⅰ型患者症状轻,治疗效果好,死亡率低（7%）.Ⅱ型与Ⅲ型患者症状重,死亡率高（分别为13.3%,16.6%）.结论 本文提出的CT分型法有助于明确手术指征,制定治疗方案及准确判断患者预后.

Objective To analyze the therapeutic effect and prognosis according to a new CT classification of traumatic posterior occipital epidural hematomas （POEH）. Methods We classified the CT presentation of 104 patients with POEH by sinus transverses： type Ⅰ hematomas were defined as up-sinus transverses; type Ⅱ hematomas were defined as sub-sinus transverses and type Ⅲ hematomas were defined as straddling sinus transverses. The above types were divided into unilateral or bilateral subtypes. Bone flap craniotomy through a median posterior approach was performed in patients with unilateral hematoma adjacent to the midline. Bone flap craniotomy through a median suboccipital approach was adopted for patients with bilateral middle occipital hematoma. Results Type Ⅰ enjoyed mild symptoms, good curative effect and low mortality rate （7%）. Type Ⅱ and Ⅲ had serious symptoms and high mortality rate （13.3%, 16.6%, respectively）. Conclusion The classification of the CT presentation of POEH is helpful in confirming the diagnosis, drawing up the scheme of treatment and judging the prognosis.