迟发性外伤性颅内血肿30例分析

目的总结迟发性外伤性颅内血肿(DTICH)的诊治经验。方法患者均头部CT检查,首次检查于伤后1～3 h。正常8例,脑挫裂伤伴血肿9例,硬膜下血肿6例,硬膜外血肿7例,颅内积气5例。复查头部CT发现血肿时间22例于伤后3～6 h,4例于伤后3～7 d,4例伤后7d以后发现。其中脑内血肿22例(额叶10例、颞叶12例),硬膜下血肿6例,硬膜外血肿2例。血肿与受力点关系,直接着力12例,对冲部位18例。迟发性颅内血肿指首次检查(CT扫描)未发现,经过一定时间后复查发现的血肿,或手术、尸检在原无血肿部位发现血肿。其产生的机理尚不清楚。结果 30例中14例有颅骨骨折及硬脑膜中动脉破裂,5例原发血肿,11例迟发性血肿发生在颅骨骨折部位。可能与血肿清除后填塞现象解除及骨折线渗血加速有关。结论对有颅骨骨折的颅内血肿患者,如血肿不在骨折线附近,或骨折线较长,原发血肿位于骨折线的一端,血肿清除后,颅内压仍高或脑膨出者,首先应排除远隔部位骨折线附近迟发血肿的可能。

Analysis of 30 cases of delayed traumatic intracranial hematoma

Objective The delayed traumatic intracranial hematoma （DTICH）, prognosis and early diagnosis is correct or not, the treatment adequacy closely related. Methods All cases were head CT examination for the first time to check in injury after lh - 3h. The normal eight cases, brain contusion hematoma nine cases, six cases of subdural hematoma, epidural hematoma in 7 cases,pneumocephalus 5 cases. Review of head CT showed hematoma in 22 cases in the injury to 6h,4 cases of 3d ～ 1 weeks after injury,4 cases of injury one week later found. Intracerebral hematoma in 22 cases of 10 cases （frontal lobe,temporal lobe 12 cases）, six cases of subdural hematoma, epidural hematoma in 2 cases. Hematoma with force point relationship, direct focus on the 12 cases, 18 cases of hedge positions. Delayed intracranial hematoma refers to the first examination （ CT scan） is not found, the review found that the hematoma after a certain period of time, or surgery, autopsy the original hematoma parts found hematoma. The generating mechanism is unclear. Results 14 patients had a skull fracture and dural artery rupture,5 ca- ses of primary hematoma, 11 cases of delayed hematoma skull fracture site. Evacuation of hematoma after packing phenomenon may lift and the fracture line oozing acceleration related. Conclusion Skull fracture, intracranial hematoma, the hematoma is not in the vicinity of the fracture line, or the longer of the fracture line, the primary hematoma in the fracture line at one end, after evacuation of hematoma,intracranial pressure is still high or encephalocele, should be excluded fromdistant sites near the fracture line may be delayed hematoma.