儿童颅脑损伤的临床特点及手术策略（附257例分析）

目的分析总结儿童颅脑损伤的临床特点及手术方法。方法回顾性分析我院2003年1月～2010年12月收治的257例颅脑损伤患儿的临床资料,平均年龄6.3（1～14）岁,其中小于3岁者52例,3～6岁者98例,7～14岁者107例;闭合性颅脑损伤217例,开放性颅脑损伤40例。按GCS评分：13～15分92例,9～12分62例,6～8分87例,3～5分16例。其中,轻型颅脑损伤90例,中型颅脑损伤57例,重型颅脑损伤89例,特重型颅脑损伤21例。手术治疗97例,包括颅内血肿清除＋保留颅骨62例（其中环钻开颅14例）、颅内血肿清除＋去骨瓣减压术11例、颅内血肿清除＋凹陷骨折复位术18例、开放性颅脑损伤清创术或颅内异物摘除术等6例。21例患儿施行气管切开术。非手术治疗160例。结果术后按照GOS评估预后：恢复良好212例（82.5%）;中残18例（7.0%）;重残8例（3.1%）;植物生存2例（0.8%）,死亡17例（6.6%）。本组住院时间平均29（11～195）d。95例患儿获随访,随访时间6个月～2年。出现癫痫症状26例,硬膜下积液20例,交通性脑积水11例。结论儿童因解剖、生理、病理生理等与成人有所不同,容易导致颅脑损伤后原发损伤重、临床症状重、病情变化快;强调对每个患儿行个体及规范化治疗,积极预防术后并发症及癫痫的发生,及时、恰当的综合治疗,可降低病死率及致残率,且小儿神经系统修复能力强,与成人相比多预后良好。

Clinical Features and Surgical Strategies of Craniocerebral Trauma in Children: A Report of 257 Cases

Objective To analyze the clinical features and surgical treatment of traumatic brain injury in children.Methods The clinical data of 257 children with traumatic head injury admitted to our hospital from January 2003 to December 2010 were analyzed retrospectively.The patients aged from 1 to 14 years with an average of 6.3 years,including 52 cases aged less than 3 years,98 cases aged from 3 to 6 years,107 cases aged from 7 to 14 years.Among them,there was closed craniocerebral injury in 217 cases and open craniocerebral injury in 40 cases.The Glasgow coma score revealed 13 to 15 score in 92 cases,9 to 12 score in 62 cases,6 to 8 score in 87 cases and 3 to 5 score in 16 cases.The craniocerebral injury was mild in 90,moderate in 57,severe in 89 and extra-severe in 21.Surgical interference was performed in 97 cases,including 62 cases of evacuation of intracranial hematoma with skull retain（trephine craniotomy in 14 cases）,11 cases of evacuation of intracranial hematoma with the decompressive craniectomy,18 cases of evacuation of intracranial hematoma with the depression fracture reduction surgery,and 6 cases of open debridement of head injury or intracranial foreign body removal surgery.21 patients were carried out tracheotomy.Non-surgical interference was performed in 160 cases.Results According to GOS standard,the prognostic outcome showed good recovery in 212 cases（82.5%）,moderate disability in 18 cases（7.0%）,severe disability in 8 cases（3.1%）,plant survival in 2 cases（0.8%） and died in17 patients（6.6%）.The hospital stay duration was ranged from 11 to 195 days with an average of 11 days.95 children were followed up for 6 months to 2 years.Traumatic epilepsy was appeared in 26 children,subdural effusion in 20 children and communicating hydrocephalus in 11 children.Conclusions The serious primary damage,severe symptom and fast pathogenetic condition development were the clinical features of craniocerebral trauma in children.The individual and standardized treatment should be emphasized in the treatment including active postoperative complication prevention and timely and appropriate combined modality therapy to reduce the mortality and morbidity.The good prognosis was easier to achieve in children because of better restoration ability in their nervous system.