摘要
目的:探讨脑外伤后跨窦急性硬膜外血肿并骨折发生脑静脉窦回流障碍(CVFO)的早期诊断和治疗方法。方法:回顾性分析跨窦硬膜外血肿和/或骨折患者403例,所有患者均早期行MRV检查,部分行CTV检查。对CVFO患者给予早期静脉应用小剂量尿激酶治疗,对损伤占位效应明显且早期出现脑疝的患者,积极手术解除机械压迫。结果:跨窦硬膜外血肿并骨折131例,CVFO 107例(81.7%);单纯跨窦线形骨折242例,CVFO 100例(41.3%);跨窦凹陷骨折30例,CVFO 24例(80.0%)。跨窦硬膜外血肿并骨折与跨窦凹陷骨折患者的CVFO发生率均显著高于单纯跨窦线形骨折患者(P<0.001)。231例CVFO患者中有88例影像学随访3月,再通良好53例,好转18例,无明显改变16例,变差1例。结论:跨窦硬膜外血肿并骨折后并发CVFO的机率较高,且其风险随损伤程度而增大。早期诊断和尿激酶干预是静脉窦回流恢复通畅的关键。
Objective： To investigate the early diagnosis and treatment for patients with cerebral venous flow obstruction （CVFO） secondary to transsinus acute epidural hematoma （EDH） and concurrent bone fracture. Methods：The clinical data of 403 patients with transsinus acute EDH and bone fracture was analyzed retrospec-tively. All the patients underwent radiographic examinations by MRV and adjuvant CTV as early as on admission to identify potentially complicated CVFO. Then the CVFO patients were treated with low-dose urokinase via intravenous drip. For patients having traumatic lesions with mass effect and/or brain hernia at a quite early time after injury, surgical intervention was performed to relieve the mechanical compression. Results：CVFO was found in 107 （81.7%） out of 131 patients with concurrent transsinus EDH and fracture, in 100 （41.3%） out of 242 patients with simple transsinus linear fracture, and in 24 （80.0%） out of 30 patients with transsinus depressed fracture. The incidences of CVFO in patients with transsinus EDH and fracture and those with transsinus depressed fracture were significantly higher than those with simple transsinus linear fracture （ P〈0.001）. Furthermore, among theoe 231 CVFO patients, 88 patients obtained adequate radiological follow-up. Radiological examinations at 3 months postoperatively demonstrated that cerebral sinuses were recanalized in 53 patients, improved in 18 patients, stabled in 16 patients, and deteriorated in 1 patients. Conclusion：Transsinus EDH and fracture were associated with high risk of secondary CVFO, which increases with the extent of primary traumas. Early diagnosis and urokinase inter-vention is critical for substantial outflow of cerebral venous sinus.
出处
《神经损伤与功能重建》
2014年第5期401-403,共3页
Neural Injury and Functional Reconstruction
关键词
颅脑损伤
跨窦硬膜外血肿
静脉窦回流障碍
尿激酶
溶栓治疗
traumatic brain injury
transsinus epidural hematoma
cerebral venous flow obstruction
urokinase
thrombolytic therapy
