外伤性颅内静脉窦闭塞的危险因素及早期诊断策略  

Risk factors for traumatic intracranial venous sinus occlusion and its early diagnosis strategies

作　　者：李军[1] 魏梁锋[1] 许丙洋 张小军[2] 王守森[1] 

机构地区：[1]南京军区福州总医院神经外科,福州350025 [2]解放军第八五医院

出　　处：《中华神经外科杂志》2015年第5期448-452,共5页Chinese Journal of Neurosurgery

基　　金：福建省科技计划重点项目（2010Y0043）

摘　　要：目的 分析外伤性颅内静脉窦闭塞（CVSO）的危险因素,探讨早期诊断外伤性CVSO的策略.方法 回顾性分析2011年8月至2013年5月南京军区福州总医院神经外科收治的240例创伤性中、重型闭合性颅脑损伤患者的临床资料,采用Logistic回归分析评估外伤性CVSO的危险因素.结果 240例创伤性颅脑损伤患者中,CVSO患者共40例,分为3型：血栓型静脉窦闭塞（Ⅰ型CVSO）、压迫型静脉窦闭塞（Ⅱ型CVSO）以及混合型静脉窦闭塞（Ⅲ型CVSO）.跨静脉窦的颅骨骨折（OR=8.03;95％ CI：3.11 ～ 20.73）和跨静脉窦的硬膜外血肿（OR=3.06;95％ CI：1.36 ～6.92）是CVSO的危险因素,其中跨静脉窦的颅骨骨折与CVSO的相关性更为显著.女性（OR=10.31：95％CI：1.72～61.94）为Ⅰ型CVSO的危险因素;跨静脉窦的硬膜外血肿（OR =5.65;95％ CI：1.77～18.08）为Ⅱ型CVSO的危险因素;既往静脉血栓病史（OR=11.28;95％ CI：1.32～96.66）为Ⅲ型CVSO的危险因素.结论 在外伤性CVSO的早期诊断中,应关注跨静脉窦的骨折线和硬膜外血肿,重视静脉血栓病史的追查.此外,MR静脉造影/CT脑静脉造影有助于早期确诊CVSO.Objectives To analyze the risk factors for traumatic cerebral venous sinus occlusion （CVSO） and to investigate the strategies of early diagnosis of traumatic CVSO.Methods The clinical data of 240 patients with moderate to severe closed traumatic brain injury admitted to the Department of Neurosurgery,Fuzhou General Hospital of Nanjing Military Command from August 2011 to May 2013 were analyzed retrospectively.Logistic regression analysis was used to evaluate the risk factors for traumatic CVSO.Results Of the 240 patients with traumatic brain injury,there were 40 patients with CVSO.They were divided into three types：CVSO of thrombotic type （CVSO type Ⅰ）,CVSO of compression type （CVSO type Ⅱ）,and CVSO of mixed type （CVSO type Ⅲ）.Skull fracture （OR,8.03;95% CI 3.11-20.73） and epidural hematoma （OR,3.06;95% CI 1.36-6.92）of crossing venous sinus were the risk factors for CVSO,and the former was more significantly correlated with CVSO.Female gender （OR,10.31;95% CI 1.72-61.94） was the risk factor for CVSO type Ⅰ;epidural hematoma of crossing venous sinus （OR,5.65;95% CI 1.77-18.08） was the risk factor for CVSO type Ⅱ;and the previous history of vein thrombosis （OR,11.28;95% CI 1.32-96.66） was the risk factors for CVSO type Ⅲ.Conclusions In the early diagnosis of traumatic CVSO,the crossing venous sinus fracture line and epidural hematoma should be given attention.Attention should be paid to tracing the history of venous thrombosis.In addition,MR venography and CT venography contribute to early diagnosis of CVSO.

关 键 词：静脉窦血栓形成 颅内 颅脑损伤 危险因素 回顾性研究 

分 类 号：R651.1[医药卫生—外科学]