外伤性进展性硬脑膜外血肿（附93例报告）

Traumatic progressive epidural hematomas： reports of 93 cases

目的探讨外伤性进展性硬脑膜外血肿（TPEDH）的临床特点和早期诊治方法。方法回顾性总结93例TPEDH的临床、影像学资料和预后结果，并结合文献进行分析。结果本组93例中男72例，女21例，平均年龄（33±12）岁；受伤至TPEDH确诊的平均时间为（8±13）h；41例为首次cT扫描上少量出血的增大，52例为新发血肿；其中28例为首次开颅减压术后发生。血肿部位以颞顶部和额颞部最多见（54％），其次为额部、顶部、枕顶部和枕部；本组单侧83例，双侧10例。以意识障碍加重为最常见的临床表现，术后发生者则以颅内压增高为突出表现。本组5例保守治疗，88例手术治疗，其中同时去除骨瓣33例。83例TPEDH处有骨折存在。本组出院时GOS评分5分56例，4分20例，3分10例，2分3例，1分4例。结论TPEDH多于伤后12h内发生，冲击部位最多见，颅骨骨折是其发生的根本因素。动态神经状态评估和CT复查有助于早期诊断，对有占位效应的TPEDH及肘手术清除有助于改善预后。

Objective To investigate the clinical characteristics and methods for early diagnosis and treatment of traumatic progressive epidural hematoma （TPEDH）. Methods The clinical and radiological data and outcome of 93 patients with TPEDH were reviewed retrospectively. On basis of reviewing literatures, results of these cases were analyzed. Results Among the 93 cases, 72 were male and 21 were female, with an average age was 33 12 years. The average interval time from injury to the confirmed diagnosis of TPEDH was 8 13 hours. TPEDH was formed by the enlargement of small hemorrhage on initial CT scanning in 41 cases, and in the other 52 cases, the TPEDH occurred in the location of no hemorrhage on initial CT scanning. Among them, TPEDH in 28 cases was found after initial decompressive cranioctomy. The most common locations of TPEDH were tempo - parietal region and fronto - temporal region, followed by frontal, parietal, parieto - occipital and occipital region. The TPEDH was unilateral in 83 cases and bilateral in 10. Deterioration of consciousness was the most common manifestations and increased ICP after operations was the dominating manifestations in the cases who received initial decompressive cranioctomy. Conservative therapy was used in 5 cases and surgery in the other 88. primary decompressive craniectomy was made in 33 cases. Skull fracture was confirmed in 83 cases beneath TPEDH. According Glasgow Outcome Scale （GOS） , scores of 5,4, 3,2 and 1 was experienced in 56, 20, 10, 3 and 4 patients respectively on discharge. Conclusion Most TPEDH oecurres within the first 12 hours after injury and located in the impact site. Skull fracture in the impact site was the basic risk factor for the occurrence of TPEDH. Dynamic evaluations and repeated head CT scanning would contribute to the early diagnosis and improvement of the outcome if the occupying TPEDH was evacuated promptly.