单纯型急性硬膜下血肿的影像学表现及治疗  

Image features of pure type acute subdural hemorrhage and its surgical outcome

作　　者：孔成[1] 黄礼明[2,3] 吴旭[2,3] 卢刚[2,3] 

机构地区：[1]浙江省磐安县人民医院神经外科 [2]浙江省人民医院神经外科 [3]浙江杭州310014

出　　处：《中国医药科学》2013年第5期128-130,共3页China Medicine And Pharmacy

摘　　要：目的分析单纯型急性硬膜下血肿的影像学特征及其相应的手术疗效。方法回顾性分析2010年1月～2011年12月收治的23例单纯型急性硬膜下血肿的临床和影像学资料。结果患者人院时GCS评分5～12分。急诊头颅CT扫描检查9例为硬膜下新月形高密占位影，混杂高低密度影12例，间隔状或高低分层密度影2例；中线结构偏移0．5-2．0cm，血肿量平均55mL。均行标准大骨瓣开颅血肿清除减压手术治疗，术中证实急性硬膜下出血源于单纯皮层动脉破裂2例，桥静脉和侧裂静脉损伤9例，上矢状窦损伤6例，岩上窦损伤3例，横窦损伤2例，横窦及乙状窦交界处损伤1例。出院按GOS评分，死亡1例，重残6例，中残11例，恢复良好5例。结论根据患者的影像学表现、意识状况和病情进展准确把握手术时机是决定单纯型急性硬膜下血肿预后的关键。Objective To investigate the image features of pure type ASDH and its surgical outcome. Methods The clinical data of 23 patients underwent surgical intervention for pure type of ASDH between Jan 2010 and Dec 2011 were reviewed and the image features were also analyzed. Results Grading scale of GCS was 5-12 in 23 patients assessed at administration. Emergency head CT scans were performed in all 23 cases. Crescent-shaped subdural hematoma was revealed as a high density in 9 cases and mixed high and low density in 12 patients. Hematoma with mixed density in layering and gap-shape were demonstrated in 2 patients. Midline shift were 0.5-2.0 cm measured in this serial and the volume of hematoma was 55 mL in average. Standard large bone flap craniotomy was performed for removing hematoma and decompression. ASDH due to pure cortical arterial rupture was evidently demonstrate in 2 patients,drainage and Sylvian vein injury in 9 cases,upper sagittal sinus injury in 6 cases,upper petrosal sinus injury in 6 cases,transverse sinus injury in 2 case,and transverse sinus and sigmoid sinus commissural injury in one patient during the operations. GCS was assessed for patients at discharge. One case died,6 patients were of serious disabled and 11 cases of mild disabled,5 patients recovered. Conclusion It may improve the prognosis of ASDH to treat the patient at appropriate operative timing based on the image features, consciousness and progression.

关 键 词：急性硬膜下血肿 单纯型 手术疗效 影像学表现 

分 类 号：R651.15[医药卫生—外科学]