外伤性脑积水的早期诊断与处理  

Early diagnosis and treatment of post-traumatic hydrocephalus

作　　者：马延斌[1] 朱志安[1] 邱建华[1] 张红[1] 肖波[1] 赵希敏[1] 冯东福[1] 

机构地区：[1]上海第二医科大学附属宝钢医院神经外科,上海201900

出　　处：《创伤外科杂志》2003年第6期403-405,共3页Journal of Traumatic Surgery

摘　　要：目的　探讨外伤性脑积水早期诊断方法与治疗措施。方法　回顾性分析 1 993～ 2 0 0 2年收治的4 5 2例重度颅脑外伤并发外伤性脑积水 73例的临床资料 ;分析近 5年来对相关病人采用的大骨瓣入路和持续腰大池置管外引流等方法 ,并比较采用此术式前后脑积水的发生率。结果　本组出现外伤性脑积水 73例(1 6 .2 % ) ;脑积水患者入院时GCS平均水平明显低于总体水平 (P <0 .0 1 ) ;73例中 ,出现脑疝征 4 7例(6 4 .4 % ) ,明显高于无脑积水患者脑疝征的发生率 1 3.5 % (P <0 .0 1 )。比较特征性的改变是侧脑室的下角在伤后早期出现向两侧下外方的移位和变形。采用大骨瓣入路和持续腰大池置管外引流后 ,脑积水的发生率为 9.5 % ,低于前期水平 (P <0 .0 1 )。结论　入院时的脑疝征与低GCS可提示临床早期关注脑积水的发生。侧脑室的下角在伤后早期出现向两侧下外方的移位和变形是脑积水早期诊断的可行性指标。Objective To investigate the early diagnosis and treatment of post traumatic hydrocephalus.MethodsClinical data obtained from 452 cases of severe head injury from 1993 2002 were selected for this study,among which 73 cases with PTH were analyzed retrospectively. Basic large bone flap craniotomy and serial lumbar punctures CSF drainage were performed in recent 5 years. The incidence of PTH before and after operation was compared.Results There are 73 patients(16.2%) with post traumatic hydrocephalus. The GCS score of the patients with PTH was significantly lower than the average(P<0.01),47 patients(64.4%) with PTH suffered from herniation,which was significantly higher than non PTH(13.5%,P<0.01). The dilated and deformation of temporal horn is usually the earliest sign of developing hydrocephalus. It was found that PTH incidence of the patients (9.5%) with basic large bone flap craniotomy and serial lumbar punctures CSF drainage was significantly fewer than that of the control group.Conclusion PTH was related closely to the initial GCS score and herniation. The changes of temporal horn are helpful indices to find PTH as early as possible. The basic large craniotomy and serial lumbar punctures CSF drainage are effective in reducing incidence of PTH.

关 键 词：创伤 脑积水 诊断 治疗 

分 类 号：R651.15[医药卫生—外科学]