儿童外伤性单纯性硬膜外血肿83例

Isolated epidural hematoma in children： a report of 83 cases

目的 探讨儿童外伤性单纯性硬膜外血肿（EDH）的诊疗及预后. 方法 回顾性分析2012年1月-2014年10月诊治的83例儿童单纯外伤性EDH的临床资料.其中男45例,女38例;年龄0.7 ～14岁.跌伤和坠落伤为主要致伤原因,随着年龄增长交通伤发生率增加.血肿部位额部为主16例,颞部为主28例,顶部为主13例,枕部9例,后颅窝17例. 结果 手术治疗28例,按格拉斯哥预后评分（GOS）：恢复良好22例,轻残2例,重残1例,死亡3例中静脉窦破裂出血2例,大面积脑硬死1例.非手术治疗55例,其中恢复良好52例,轻残1例,死亡2例入院时均双侧瞳孔散大,其中1例无自主呼吸. 结论 儿童外伤性单纯性EDH总体预后良好,早期诊治及严密动态观察对预后至关重要;硬膜外血肿并发静脉窦破裂、枕骨大孔疝及大面积脑梗死是预后不良的主要原因.

Objective To investigate the diagnosis,treatment and prognosis of isolated epidural hematoma （EDH） in children.Methods Clinical data of 83 children,45 males and 38 females （at age of 0.7-14 years）,with EDH treated between January 2012 and October 2014 were retrospectively reviewed.Slipping and falling were the most commonly causes of injury.While motor-vehicle accident was noted with increased age.In 16 patients lesion of hematoma was frontal,in 28 patients temporal,in 13 patients parietal,in 9 patients occipital and in 17 patients posterior fossa.Results Of the 28 patients treated surgically,the outcome evaluated using the Glasgow Outcome Score （GOS） was good in 22 patients,mild disability in 2,moderate and severe disability in 1 and death in 3 （one died of venous sinus rupture and one large area infarction）.Of the 55 patients treated conservatively,the outcome was good in 52 patients,mild disability in 1,and death in 2 （both presented with bilateral cerebral hernia on admission and one of them was unable to breath spontaneously）.Conclusions Overall prognosis of the patients with isolated EDH in children is excellent.Complications of venous sinus rupture,foramen magnum hernia and large area cerebral infarction may contribute to poor prognosis.