新生儿硬膜外血肿伴颅骨骨折及头颅血肿治疗方法初探

摘要

Objective To study the effeet of skull hematoma aspiration drainage in neonatal epidural hematoma with skull hematoma and skull fracture.Methods The clinical manifestations and imaging characteristics of 4 neonates with epidural hematoma with skull fractures from 2012 to 2013 were summarized.All four eases underwent hematoma aspiration drainage and the imaging before and after the aspiration were compared.All four eases were followed up.Results The visible skull hematoma were found in 4 cases.Two patients had no clinical neurological manifestations,but the skull hematoma grew bigger in one of them; 1 patient had neurological symptoms of excitement 1 hr after birth,but without seizures; 1 patient had seizures 21hr after birth,and still showed decreased muscle tone 6 days later.skull hematoma,epidural hematoma and skull fracture were found on brain imaging in four cases.All four cases aspiration drainage of skull hematoma at 3-9 d after birth.3-24 ml blood was drained,and the epidural hematoma significantly reduced.One patient underwent the procedure twice.During follow-up,3 patients had normal neuro-motor development,and the patient with decreased muscle tone was much better after rehabilitation therapy.Conclusions The aspiration drainage of skull hematoma is feasible for epidural hematoma with skull hematoma and skull fracture in neonates.The blood in the epidural hematoma can be drained through the skull fracture and the epidural hematoma shrinked to relieve the pressure caused by epidural hematoma to the brain parenchyma and reduce neurological sequelae.%目的 探讨新生儿硬膜外血肿伴颅骨骨折及头颅血肿时通过头颅血肿穿刺抽血对硬膜下血肿的治疗效果.方法 对2012-2013年我科收治的4例新生儿硬膜外血肿伴颅骨骨折及头颅血肿患儿的临床表现、影像学特点进行总结;患儿均行床旁抽取头颅血肿内的血液治疗颅内硬膜外血肿.对比患儿手术前后的影像学改变,并对患儿进行随访.结果 4例硬膜外血肿患儿均有头颅血肿和颅骨骨折.2例临床无神经系统异常表现,其中1例生后头颅血肿进行性增大;1例患儿有神经兴奋症状;1例患儿生后21 h出现惊厥,生后6天仍有肌张力减低.4例患儿影像学均发现在头颅血肿对应颅内部位有硬膜外血肿并对周围脑皮质有不同程度压迫,在头颅血肿和硬膜外血肿之间的颅骨存在骨折.4例患儿分别于生后3～9天行头颅血肿穿刺,抽出血量3～24 ml不等,手术后硬膜外血肿均明显减小,其中1例抽过两次头颅血肿.2例患儿已随访1年,2例患儿随访3个月;其中3例患儿神经发育同同龄儿,1例因肌张力减低进行康复治疗,已明显好转.结论 对于伴颅骨骨折及头颅血肿的硬膜外血肿,可行头颅血肿穿刺,通过骨折缝隙将颅内硬膜外血肿的血液引流至颅外头颅血肿处,减小硬膜外血肿,达到减轻对脑实质的压迫及减少神经系统后遗症的目的.