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目的:探讨颅脑损伤术后非手术区迟发性颅内血肿的临床特征及形成机理。方法:回顾性分析29例颅脑损伤术后经CT扫描或再次开颅探查证实为迟发性血肿的发生部位、发生时间,及其与脑挫裂伤、颅骨骨折等原发伤的关系。结果:血肿发生部位与手术部位关系:邻近型8例、远隔型12例、对侧型9例;发生在脑内9例、硬膜外12例、硬膜下7例、脑室内1例;12例术后硬膜外血肿中有9例可见颅骨骨折,其中5例骨折线与脑膜血管走行交叉,3例为跨中线线形骨折,原发血肿与术后血肿各在骨折线两端,9例脑内血肿7例术前CT扫描发现血肿发生部位有不同程度脑挫裂伤;血肿发生在术后24h内16例、24～72h 8例、72h以上5例。结论:颅脑损伤术后迟发性颅内血肿中,硬膜外、硬膜下与脑内血肿形成机制不尽相同,脑挫裂伤、颅骨骨折、脑膜或皮层血管破裂、桥静脉断裂等局部损伤可导致不同类型的血肿,脑血管麻痹、低血氧症等是非手术区迟发性血肿形成的病理基础。
Objective: To investigate the clinical characteristics and the formation mechanism of delayed intracranial hematoma in nonoperative area after craniocerebral injury. Methods: A retrospective analysis of 29 cases of craniocerebral injury after CT scan or re-craniotomy proved delayed hematoma occurred site, time, and its relationship with cerebral contusion, skull fracture and other primary injury. Results: There were 8 cases of adjacent type and 12 cases of distant type and 9 cases of contralateral type in 9 cases. There were 9 cases in brain, 12 cases in epidural, 7 cases in subdural and 1 case in cerebral ventricle ; 9 cases of 12 cases of postoperative epidural hematoma can be seen skull fracture, of which 5 cases of fracture line intersects with the meninges vessels, 3 cases of trans-midline fractures, the primary hematoma and postoperative hematoma in the fracture line at both ends, Nine cases of intracerebral hematoma 7 cases of preoperative CT scan found hematoma occurred in different degrees cerebral contusion; hematoma occurred within 24h after operation, 24 ~ 72h 8 cases, 72h more than 5 cases. Conclusion: There are different mechanisms of epidural, subdural and intracerebral hematoma in delayed intracranial hematoma after craniocerebral injury. Brain contusion, skull fracture, rupture of blood vessels in the brain or cortex, rupture of the bridge vein, etc. Local injury can lead to different types of hematoma, cerebrovascular paralysis, hypoxemia and other non-surgical area of delayed hematoma pathological basis.