颅脑损伤术后迟发性颅内血肿的形成机制

Study on the pathogenesis of delayed postoperative intracranial hematoma in patients with, traumatic brain injury

目的 探讨颅脑损伤术后非手术区迟发性颅内血肿的临床特征及形成机制。方法 回顾性分析29例颅脑损伤术后经CT扫描或再次开颅探查证实为迟发性血肿的发生部位、发生时间,及其与脑挫裂伤、颅骨骨折等原发伤的关系。结果 血肿发生部位与手术部位关系:邻近型8例、远隔型12例、对侧型9例;发生在脑内9例、硬膜外12例、硬膜下7例、脑室内1例;12例术后硬膜外血肿中有9例可见颅骨骨折;9例术后脑内血肿中有7例可见脑挫裂伤。结论 颅脑损伤术后迟发性颅内血肿中,硬膜外、硬膜下与脑内血肿形成机制不尽相同,颅骨骨折、脑挫裂伤、脑膜或皮质血管破裂、桥静脉断裂等局部损伤影响不同类型血肿的形成,脑血管麻痹、低氧血症等是非手术区迟发性血肿形成的病理基础。

Objective To explore the clinical features and mechanism of postoperative delayed intracranial hematoma in patients with traumatic brain injuries. Methods Twenty-nine patients of acute head injury with delayed postoperative intracranial hematomas demonstrated by CT scanning or by second operation were investigated. The relationship between the styles of primary injuries and the onset of delayed postoperative intracranianl hematoma was retrospectively analyzed. Results Delayed intracranianl hematomas occurred near the operative site in 8 cases, far from the operative field in 12 and on the contralateral hemisphere in 9. According to the locations of the hematomas, there were 12 cases of epidural hematomas, 9 of intracerebral hematomas, 7 of subdural hematomas and 1 of intraventricular hematoma. Skull fractures were found in 9 cases of epidural hematomas, and brain contusions were found in 7 of 9 intracerebral hematomas. Conclusion The pathogenesis of the postoperative epidural, intracerebral and subdural hematoma is different; The skull fracture, brain contusion and vessel ruptures and so on may play different roles in the formation of those delayed hematomas. Cerebrovascular palsy and anoxia are the pathologic basis of the hematoma formation.