儿童外伤性基底节区卒中16例临床分析  

Clinical analysis of 16 children with traumatic basal ganglia stroke

作　　者：王光明[1] 李蕴博[1] 韦强[1] 韩彦武[1] 龙宏威 刘兴吉[1] Wang Guangming;Li Yunbo;Wei Qiang;Han Yanwu;Long Hongwei;Liu Xingji(Department of Neurosurgery,First Hospital of Jilin University,Changchun 130021,China;Department of Neurosurgery,Worker's Hospital of Liaoyuan Mineral System,Liaoyuan 136200,China)

机构地区：[1]吉林大学第一医院神经外科,长春130021 [2]辽源矿务局职工总医院神经外科,吉林省辽源136200

出　　处：《中华儿科杂志》2019年第1期46-49,共4页Chinese Journal of Pediatrics

摘　　要：目的探讨儿童外伤性基底节区卒中(TBGS)的临床特点及危险因素。方法采用回顾性病例总结,选择吉林大学第一医院于2014年1月—2017年6月收治的临床诊断为TBGS的患儿,共确诊16例TBGS患儿,其中男11例,年龄范围0.5~13.0岁。收集其临床及影像学资料,对比不同年龄段(≥5岁与<5岁)的TBGS患儿、不同外伤性卒中(梗死与出血)患儿的预后情况,不同组别预后情况比较采用Fisher′s检验。结果所有患儿均有明确头部外伤史,伤后均有不同程度的肢体瘫痪,其中4例出现面瘫,3例出现意识障碍,1例出现癫痫发作。16例患儿头部CT表现为:缺血性卒中11例,出血性卒中5例。双侧基底节散在钙化点8例。根据临床表现及影像学资料给予营养神经、改善微循环及神经康复治疗;1例患儿给予开颅血肿清除手术治疗。16例患儿中恢复健康11例,留有肢体瘫痪3例,死亡2例。外伤性基底节区梗死的11例患儿(10例恢复健康,1例留有偏瘫)较出血的5例患儿(1例恢复健康,2例留有偏瘫,2例死亡)预后相对较好(χ^2=8.045,P=0.013)。年龄较小的患儿预后较好(≥5岁8例,其中3例恢复健康,3例留有偏瘫,2例患儿死亡;<5岁8例均恢复健康;χ^2=12.121,P<0.01)。结论儿童基底节区解剖学特点及豆纹动脉的钙化等是儿童TBGS的危险因素,梗死的患儿预后相对较好,年龄较小的患儿预后较好。Objective To investigate the clinical characteristics and risk-factors of traumatic basal ganglia stroke(TBGS)in children.Methods A retrospective case study was conducted to analyze the clinical and imaging data of 16 children with TBGS in the First Hospital of Jilin University from January 2014 to June 2017.A total of 16 TBGS cases(11 males,5 females)were diagnosed and the age ranged from 0.5 to 13.0 years.The prognosis of children with TBGS at different ages(≥5 years and<5 years)and with different traumatic stroke(infarction and hemorrhage)were compared.Fisher ′s test was used to compare the prognosis of different groups.Results All cases had clear history of head trauma and varying degrees of limb paralysis after injury,including 4 cases of facial paralysis,3 cases of consciousness disturbance and 1 case of seizures.Head CT scan of the 16 cases showed 11 cases of ischemic stroke and 5 cases of hemorrhagic stroke.Moreover,scattered calcification was observed in the bilateral basal ganglia point of 8 cases.Neurotrophic treatment,microcirculation improvement and nerve rehabilitations were given according to the clinical and imaging data.One patient was treated with craniotomy and hematoma clearance.Of the 16 cases,11 cases were restored to normal,while 3 cases developed limb paralysis and 2 cases died.The prognosis of 11 cases of traumatic basal ganglia infarction(10 cases recovered and 1 case remained hemiplegic)was relatively better than that of 5 cases of hemorrhage(1 case recovered,2 cases remained hemiplegic and 2 cases died)(χ^2=8.045,P=0.013).In addition,the children younger than 5-year-old(all 8 cases recovered)had a better prognosis than the children older than 5-year-old(8 cases,3 of whom recovered,3 cases remained hemiplegia,2 cases died)(χ^2=12.121,P<0.01).Conclusions The anatomical characteristics of basal ganglia and calcification of the lenticulostriate artery are risk-factors for TBGS in children.The prognosis of infarcted children and younger children is relatively better.

关 键 词：儿童 脑损伤 颅底 卒中 

分 类 号：R726.5[医药卫生—儿科]