顶部跨上矢状窦硬膜外血肿的外科治疗策略探讨  

Surgical Management of Vertex Epidural Hematoma Straddling the Superior Sagittal Sinus

作　　者：韩瑞璋[1] 苏国军[1] 于烽[1] 赵保[1] 叶晶亮[1] 李斌[1] 张建忠[1] 

机构地区：[1]中国人民解放军第98医院脑外一科,浙江湖州313000

出　　处：《现代生物医学进展》2012年第32期6303-6306,共4页Progress in Modern Biomedicine

摘　　要：目的:探讨顶部跨上矢状窦硬膜外血肿的诊断和外科治疗策略,提高其临床治疗效果。方法:回顾分析2002年1月～2011年10月我院收治的27例颅脑创伤后发生的跨上矢状窦硬膜外血肿病例的临床资料、手术方法,总结分析其治疗效果。结果:按GOS治疗结果评定,保守治疗的15例患者均恢复良好;开颅手术的12例患者中,7例恢复良好,1例中残,1例重残,1例植物生存,2例死亡。全组病人均经头颅X线或CT检查提示血肿区域有骨折或冠状缝或矢状缝分离,并经手术证实,其中伴有上矢状窦破裂2例。单纯骨折不伴有矢状窦损伤者手术效果较好,而伴有矢状窦撕裂者预后较差。结论:顶叶跨上矢状窦硬膜外血肿临床少见,病情变化快,正确掌握顶部跨上矢状窦硬膜外血肿的诊断和把握手术指征,有助于改善其预后。Objective： To investigate the diagnosis and surgical treatment strategies of vertex epidural hematoma （VEDH） strad-dling the superior sagittal sinus and improve its clinical outcome. Methods： The clinical data, surgical procedures and the therapeutic ef-fects in 27 cases of vertex epidural hematoma after brain injury admitted in our hospital from January 2002 and October 2011 were retro-spectively analyzed. Results： According to GOS, 15 cases of conservative treatment all recovered well; in 12 cases of craniotomy, 7 cases recovered well, moderate disability was found in 1 case, severe disability was found in 1 case, plant survival was found in 1 case, 2 cases died. All patients had skull X-ray or CT scan hematoma region or coronal suture fracture or diastasis of the sagittal suture, and patients in operation group were confirmed by surgery, the superior sagittal sinus rupture was found in 2 cases. The prognosis of patients with Sim-ple vertex fracture was usually better than those associated with superior sagittal sinus torn. Conclusions： VEDH is an unusual disease in clinic, progresses quickly, so correctly grasping its diagnosis and surgery indications are helpful to improve the prognosis of those patients.

关 键 词：顶部硬膜外血肿 上矢状窦 手术 预后 

分 类 号：R651.11[医药卫生—外科学]