Gutman M B, Moulton R J, Sullivan I, Hotz G, Tucker W S, Muller P J
Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, Canada.
J Neurosurg. 1992 Jul;77(1):9-14. doi: 10.3171/jns.1992.77.1.0009.
A study was performed to examine the incidence of operable traumatic intracranial hematomas accompanying head injuries of differing degrees of severity, and to see if factors predicting operable mass lesions could be identified. Logistic analysis was used to identify independent predictors of operable traumatic intracranial hematomas. Data were gathered prospectively on 1039 patients admitted with head injury between January, 1986, and December, 1990. Patient age, Glasgow Coma Scale (GCS) score, pupillary inequality, and injury by falling were all independent predictors of the presence of operable intracranial hematomas (p = 0.0000, 0.0000, 0.0182, and 0.0001, respectively). Injury to vehicle occupants was less likely to result in operable mass lesions (p = 0.0001) than injury by other means. The incidence of traumatic intracranial hematomas in patients over 50 years old was three to four times higher than in those under 30 years of age. Not surprisingly, the incidence of operable hematomas increased with decreasing GCS scores. However, even at a GCS score of 13 to 15, patients with other risk factors had a substantial incidence of operable mass lesions. There was a 29% incidence of operable intracranial hematomas for patients with a GCS score of 13 to 15, aged over 40 years and injured in a fall. It is suggested that patients who are middle-aged or older, or those injured in falls, are at particular risk for traumatic intracranial hematomas even if their GCS score is high. These patients should have early definitive investigation with computerized tomography in order to identify operable hematomas and to initiate surgical treatment prior to neurological deterioration from mass effect.
开展了一项研究，以检查不同严重程度头部损伤伴随的可手术治疗的创伤性颅内血肿的发生率，并观察是否能够确定预测可手术治疗的占位性病变的因素。采用逻辑分析来确定可手术治疗的创伤性颅内血肿的独立预测因素。前瞻性收集了1986年1月至1990年12月期间因头部损伤入院的1039例患者的数据。患者年龄、格拉斯哥昏迷量表（GCS）评分、瞳孔不等大以及跌倒致伤均为可手术治疗的颅内血肿存在的独立预测因素（p值分别为0.0000、0.0000、0.0182和0.0001）。与其他致伤方式相比，乘车人员受伤导致可手术治疗的占位性病变的可能性较小（p = 0.0001）。50岁以上患者创伤性颅内血肿的发生率比30岁以下患者高3至4倍。不出所料，可手术治疗的血肿发生率随GCS评分降低而增加。然而，即使GCS评分为13至15，伴有其他危险因素的患者发生可手术治疗的占位性病变的发生率也相当高。GCS评分为13至15、年龄超过40岁且因跌倒受伤的患者，可手术治疗的颅内血肿发生率为29%。建议中年或老年患者，或跌倒受伤的患者，即使GCS评分较高，也特别容易发生创伤性颅内血肿。这些患者应尽早进行计算机断层扫描明确检查，以识别可手术治疗的血肿，并在因占位效应导致神经功能恶化之前启动手术治疗。
