儿童创伤性颅后窝硬脑膜外血肿的治疗

Treatment of traumatic posterior cranial fossa epidural hematoma in children

目的总结儿童创伤性颅后窝硬脑膜外血肿(PFEDH)的临床特点和诊治经验。方法回顾性分析30例经手术和(或)影像学检查确诊的儿童创伤性PFEDH的临床资料,其中车祸伤18例,坠落伤9例,跌伤3例;均有枕部着力伤。GCS评分:8～10分3例,11～12分9例,13～14分18例。根据血肿量和病人情况,采用非手术治疗或手术治疗。结果非手术治疗6例,伤后3个月复查CT血肿均完全吸收,神经系统检查未见明显异常;手术治疗24例,术后所有病儿病情平稳好转,头痛症状逐渐消失,术后CT显示血肿基本清除。本组无手术相关并发症。出院时病儿按GOS预后分级均恢复良好。结论枕部着力伴局部颅骨骨折的病儿发生PFEDH的风险大,如能早期诊断并及时处理,儿童创伤性PFEDH可获得良好疗效。

Objective To summarize the clinical features and treatment experience of traumatic posterior cranial fossa epidural hematomas（PFEDH） in child.Methods Clinical data of 30 patients with PFEDH diagnosed by surgery or imaging were analyzed retrospectively,including traffic accident injury in 18 cases,crash injury in 9,falling injury in 3,and all patients accompanied with occipital impact.The GCS scores were as follows： 8 to 10 scores in 3 cases,11 to 12 in 9,13 to 14 in 18.Surgical or conservative treatment was adopted according to the volume of hematoma and conditions of patients.Results Conservative treatment was performed in 6 patients,and the hematoma was completely absorbed according to CT 3 months after operation,and the neurological examination revealed no obvious abnormality.Surgical treatment was performed in 24 patients,whose state was stably improved,headache disappeared gradually,and the hematoma was basically absorbed according to CT postoperatively.No complications related to operation occurred.Good recovery was achieved in all patients according to GOS scores.Conclusions The patients with occipital impact and skull fracture have a higher risk of developing into PFEDH,and early diagnosis and prompt treatment of traumatic PFEDH can achieve satisfactory outcomes in children.