小儿急性外伤性双侧硬膜外血肿

目的：观察小儿急性外伤性双侧硬膜外血肿的临床特点，分析其形成机制，探讨其早期诊断要点及有效的手术治疗方法。方法对收治的21例小儿急性外伤性双侧硬膜外血肿患者的临床、影像资料及预后进行分析。结果21例患儿年龄4个月～16岁，平均年龄6.88岁。其中双侧跨中线单个血肿5例，双侧不同部位2个及2个以上血肿16例。首次头部CT检查发现双侧血肿12例，另外9例通过复查发现迟发性血肿。患儿入院时格拉斯哥昏迷评分13～15分8例，9～12分11例，≤8分2例。手术治疗8例，其中行双侧手术7例，单侧手术1例；保守治疗13例。除1例死亡外，余患儿均恢复良好。结论一侧硬膜外血肿开颅手术后对侧迟发硬膜外血肿较难早期发现，易导致预后不良，动态CT扫描可及时发现双侧硬膜外血肿并观察到血肿的变化；小儿双侧硬膜外血肿早期发现并及时采取个体化治疗方能预后良好。

Acute traumatic bilateral epidural hematomas in children

Objective To observe and the clinical characteristics in children with acute traumatic bi-lateral eip dural hematomas,analyze the formation mehc ansi ms and explore the early diagnso is strategies and effective surgical treatment methods.Methods From August 2004 to December 2013,21 cases(17 males,4 females) of pediatric patients with acute traumatic bilateral epidural hematomas were treated in our hospital, and the clinical materials,imaging data and prognosis were summarized and analyzed.Results The 21 pedi-atric patients were aged from 4 months to 16 years,the mean ga e was 6.88 years.Bilateral single epidural hematoma across the superior sagittal sinus was found in 5 cases,bilateral double or more hematomas in both sides of the midline were observed in 16 cases.Initial CT scan showed simultaneous bilateral hematomas in 12 cases;while in 9 cases of bilateral hematomas were found with a delayed onset by the reviewed CT.The admitting glasgow coma score was between 13-15 in 8 cases,9-12 in 11 cases and 3-8 in 2 cases.Surgi-cal treatment was performed in 8 cases,including 7 cases with bilateral operations and 1 case with unilateral operation.Thirteen cases were managed consevr atively.Exec pt one death case, all other children were well er covered to normal lives.Conclusion Delayed contra-lateral epidural hematomas following evacuation of a prior EDH can lead to poor outcome because of usually delayed discovery.Early dynamic CT scans can detect bilateral epidural hematomas and observe their changes in time.Early detectiona nd prompt individual treat-ment should be applied in children with bilateral epidural hematomas to get good prognosis.