儿童后颅窝硬膜外血肿35例临床分析  

Posterior fossa epidural hematomas in children： a clinical analysis of 35 cases

作　　者：王子德[1] 于如同[1] 祁正磊 沈志刚[1] 苗发安[1] 谢满意[1] 纪培志[1] 王强[1] 

机构地区：[1]徐州医学院附属医院神经外科,221000

出　　处：《中华神经外科杂志》2016年第4期358-361,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨儿童后颅窝硬膜外血肿的临床特点、影像学表现、治疗方法及预后。方法回顾性分析2010年8月至2015年4月徐州医学院附属医院神经外科收治的35例儿童外伤性后颅窝硬膜外血肿患儿的临床资料。采用保守治疗18例；钻孔引流治疗8例，其中3例因术后血肿部分残留行尿激酶治疗；开颅手术9例。结果18例保守治疗的患儿均于发病后1个月左右复查CT显示血肿吸收；钻孔引流的8例患儿，术后血肿量残留〈5ml；开颅手术的9例患儿，术后血肿清除彻底。随访4个月至5年，所有患儿恢复良好，无手术致死及致残的患儿。结论儿童后颅窝硬膜外血肿发生相对较多，以高处坠落伤及跌倒伤为主，人字缝分离性骨折及枕骨骨折是出血的主要原因；头痛、呕吐及意识障碍对病情判断较重要；急性期血肿极易液化，钻孔引流对液化血肿的治疗安全有效；儿童后颅窝硬膜外血肿早期诊断并及时而恰当治疗预后良好。Objective To investigate the clinical features, imaging findings, treatment and prognosis of posterior fossa epidural hematomas in children. Methods From August 2010 to April 2015, the clinical data of 35 children with traumatic posterior fossa epidural hematoma admitted to the Department of Neurosurgery, the Affiliated Hospital of Xuzhou Medical College were analyzed retrospectively. Eighteen of them were treated conservatively 8 were treated with skull drilling and drainage. Three of which received urokinase therapy because part of residual hematoma after procedure, and 9 were treated by craniotomy. Results In 18 children treated with the conservative treatment, CT revealed that their hematomas were absorbed about 1 month or so after symptom onset. The residual hematomas 〈 5 ml after procedure in 8 children were treated with skull drilling and drainage, and 9 were treated with craniotomy, their hematomas were removed completely after procedure. They were followed up for 4 months to 5 years. All children recovered well, without operation death and disability. Conclusions The occurrence of posterior fossa epidural hematomas in children are relatively more common. Most of them are falling and shpping injuries. The lambdoid suture separation fracture and occipital fracture are the main causes of bleeding. Headache, vomiting and disturbance of consciousness are more important for identifying the disease. Hemotomas in acute phase are easy to be liquefied. Drilling skull and drainage are safe and effective for the treatment of liquefied hematomas. The early diagnosis and appropriate treatment of posterior fossa epidural hematomas in children have good prognosis.

关 键 词：血肿 硬膜外 颅内 儿童 治疗 

分 类 号：R726.5[医药卫生—儿科]