21例儿童创伤性颅内静脉窦血栓的临床分析

Clinical analysis of traumatic cerebral venous sinus thrombosis in children

目的探讨儿童创伤性颅内静脉窦血栓的形成机制、临床表现、治疗方案及预后。方法回顾性分析我院2009年1月至2019年12月收治创伤性颅内静脉窦血栓患儿临床资料,总结其临床表现、形成机制、影像学特点,对比肝素与非肝素治疗效果。结果本组患儿共21例,主要临床症状为头痛、呕吐及活动量减少,颅内压增高[(30.53±5.07)cm H_2O],视乳头水肿发生率高(81%)。血栓形成部位多伴有跨窦的颅骨骨折或硬膜外血肿;血栓初次减少的时间为(18.33±6.15) d,肝素组显著短于非肝素组[(15.00±5.13) d vs(23.75±2.96)d,P<0.001],血栓残余平均比率为11%(3.0%,14.5%),肝素组血栓残余比率为5%(2%,13%),显著低于非肝素组[12.5%(10.5%,24.7%),(P<0.05)]。两组间的血栓稳定时间[(31.08±8.81)d vs(37.75±5.01)d]及D-二聚体减少时间[(12.92±4.62)d vs(14.62±2.82)d]差异无统计学意义(P>0.05)。结论儿童创伤性颅内静脉窦血栓常见于跨静脉窦的颅骨骨折及压迫静脉窦的硬膜外血肿,抗凝治疗可使血栓初次减少时间缩短,血栓残余比缩小,加速血栓再通,再通效果更佳,短期预后较好。

Objective To investigate the mechanism of formation of traumatic cerebral venous sinus thrombosis(CVST)in children and analyze the clinical manifestations,treatment and prognosis of CVST.Methods We performed a retrospective analysis of 21 children with traumatic CVST treated in our hospital between January 2009 and December 2019.The clinical manifestations,causes of thrombosis,imaging characteristics and the effects of heparin versus non-heparin treatments were analyzed.Results Among the 21 children with CVST,the main clinical symptoms included headache,vomiting,decreased activity,increased intracranial pressure(30.53±5.07 cmH2O),and papilledema(81%).Cranial fractures involving different sinuses or epidural hematoma was common in the children with CVST.The time of first-time hematoma volume reduction was 18.33±6.15 d in these children,and was significantly shorter in children receiving low-molecular-weight heparin(LMWH)treatment than in those without LMWH treatment(15.00±5.13 vs 23.75±2.96 d,P<0.001).The percentage of residual hematoma was meanly 11%(3.0%,14.5%)in the cohort,and it was significantly lower in children with LMWH treatment than in those without[5%(2%,13%)vs 12.5%(10.5%,24.7%);P<0.05)].The hematoma stabilization time was 31.08±8.81 d and 37.75±5.01 d and the D-dimer stabilization time was 12.92±4.62 d and 14.62±2.82 d in LMWH group and non-LMWH group,respectively,showing no significant differences between the 2 groups(P>0.05).Conclusion CVST in children often occurs following skull fracture across the venous sinuses or epidural hematoma that compresses the venous sinus.Anticoagulation therapy can shorten the time of hematoma volume reduction,reduce the volume of residual hematoma,and accelerate recanalization to improve the short-term outcomes of the patients.