外伤性硬膜下积液演变成慢性血肿43例临床分析

目的:探讨外伤性硬膜下积液(TSE)转化成慢性硬膜下血肿(CSDH)的临床特点及演变机制。方法:回顾性分析43例由TSE最后演变成CSDH的临床资料及有关文献资料。结果:43例均有明确的头部外伤史,50岁以上者31例,36例原发脑损伤轻,4例并发蛛网膜下腔出血。病变位于颞顶10例,额颞19例,额颞顶14例。31例接受过脱水治疗,9例病人有再次受伤史。TSE至形成CSDH的时间:1~2月17例,2~3月14例,占72.1%。43例病人均恢复良好无复发。结论:TSE多经过1~3月演变成CSDH。外伤史明确,原发脑损伤轻。老年人多见,多位于蛛网膜与骨嵴有粘连处或薄弱处。脑脊液与血液混合是TSE转化成CSDH的始动因素。

Clinical analysis of chronic subdural hematomaevolving from traumatic subdural effusion in 43 cases

Objective:To study the clinical characteristics and mechanism of chronic subdural hematoma(CSDH) evolving from traumatic subdural effusion(TSE).Methods: Clinical data of 43 patients with CSDH evolving from TSE were analyzed retrospectively and the correlative references were reviewed.Results: 43 cases had all clear history of head injury;31 cases were above 50 years of age.Mild primary brain injury occurred in 36 cases;accompanying subarachnoid hemorrhage in 4 cases.Lesions located in temporal-parietal lobe were 10 cases,in frontal-temporal lobe were 19 cases,and in frontal-temporal-parietal lobe were 14 cases.31 cases had received dehydration therapy,9 cases had over wounded history.The time of conversion: 1～2 months in 17 cases,2～3 months in 14 cases,accounting for 72.1%.43 cases had recovered well and not recurred.Conclusion: Most TSE developed to CSDH from 1 to 3 months.All the patients had clear history of head injury and mild primary brain injury and were old patients.There lesions were located in the place where arachnoid membrane adheres to bone bridge or where arachnoid is frail.The mixture of cerebrospinal fluid and blood was the beginning agent of conversion from TSE to CSDH.