外伤性后颅窝血肿117例临床分析  

Clinical analysis of 117 cases of traumatic hematoma of the posterior fossa

作　　者：黄甫 骆纯[2] 何勇 王家清[4] 俞国鑫[5] 朱诚[2] 张光霁[2] 

机构地区：[1]浙江省乐清市第三人民医院脑外科,浙江乐清325604 [2]第二军医大学长征医院神经外科,上海200003 [3]江西省玉山县人民医院神经外科,江西玉山334700 [4]解放军107医院神经外科,山东烟台264002 [5]浙江省新昌县人民医院脑外科,浙江新昌312500

出　　处：《中华神经医学杂志》2004年第5期353-355,共3页Chinese Journal of Neuromedicine

摘　　要：目的 分析总结外伤性后颅窝血肿的诊断和治疗特点。方法 对1990年1月至2002年12月117例外伤性后颅窝血肿的病因学、影像学、诊断和治疗特点进行分析。结果 本组117例外伤性后颅窝血肿中硬膜外血肿76.06％(89例),其中跨幕上下者60.67％(54例),硬膜下血肿4.27％(5例),小脑脑内血肿19.66％(23例)。合并幕上对冲性脑损伤52例,合并原发脑干伤9例。本组95例行血肿清除术及综合治疗,22例采用保守治疗,其中18例小脑脑内血肿,3例后颅窝硬膜外血肿和1例硬膜下血肿(出血量<10 mL)。伤后6个月行GOS评估,死亡12例,重残2例,其余预后良好。结论单纯后颅窝血肿应及时诊断并手术,预后良好,即使合并幕上血肿,只要及时治疗,也能取得满意效果。Objective To study the diagnostic and therapeutic features of traumatic hematoma of the posterior fossa. Methods The clinical data, including clinical manifestation, etiologic, radiographic and therapeutic features in 117 cases of traumatic hematoma of the posterior fossa, admitted from January, 1990 to December, 2002 after the introduction of CT scanning, were analyzed. Results In this group, epidural hematomas were the most common traumatic mass lesion of the posterior fossa, accounting for 76.06% (89 cases), while subdural and intracerebellar hematoma were 4.27% (5 cases) and 19.66% (23 cases) respectively. Of the epidural hematomas, 60.67% (54 cases) extended above and below the tentorium. 52 cases developed supratentorial contrecoup brain injuries and 9 cases, primary brain stem injuries. 22 cases (hematoma volume < 10mL) were treated with conservative methods; the other cases underwent the surgical evacuation of posterior fossa hematoma. 6 months later, Glasgow Outcome Scale (GOS) scores showed that the proportions of good recovery, death and severe disability were 88.03%, 10.26% and 1.71% respectively. Conclusion The timely diagnosis and proper management are essential for the sound prognosis of the posterior fossa hematoma, even if it comes to supratentorial hematoma, the desirable outcome can be achieved by accurate and prompt treatment.

关 键 词：外伤性后颅窝血肿 硬膜外血肿 诊断和治疗 小脑 硬膜下血肿 脑内血肿 预后 

分 类 号：R651.15[医药卫生—外科学] R743[医药卫生—临床医学]