Balik V, Lehto H, Hoza D, Phornsuwannapha S, Toninelli S, Romani R, Sulla I, Hernesniemi J
University Hospital Olomouc, Department of Neurosurgery, Olomouc, Czech Republic.
Cent Eur Neurosurg. 2011 Nov;72(4):169-75. doi: 10.1055/s-0031-1286261. Epub 2011 Oct 19.
The purpose of this study was to analyse the differences between patients with frontal (FEDH) or parieto-occipital (POEDH) epidural haematomas and evaluate possible statistically significant prognostic factors.
In this retrospective study of a group of 41 patients with a FEDH (17) or POEDH (24 individuals), the authors analysed the influence of gender, age, type of injury, clinical presentation, Glasgow coma scale (GCS) score on admission, radiological findings, and time interval from trauma to surgery on outcomes. A good recovery and moderate disability were considered a "good" or "favourable outcome", whereas severe disability, a vegetative state or death was a "poor outcome".
In the POEDH subgroup, a higher GCS score on admission and a younger age were statistically significant prognostic factors for a better outcome (p=0.006, rs=0.702). In the subgroup of patients with FEDHs, the results were not significant. However, patients with FEDHs more frequently had "good outcomes" than members of the POEDH subgroup (88.2 vs. 70.9%). Children (≤ 18 years old) constituted a smaller portion of the POEDH subgroup (12.5%) than those in the FEDH subgroup (41.2%). The evaluation of time intervals between the accident and surgery (≤ 24 h vs. > 24 h) showed no significant influence on outcomes in any of the studied subgroups. However, patients undergoing surgery within 24 h of their injury had a less favourable GCS score on admission than those operated on more than 24 h after their injury. Subacute and chronic clinical courses predominated in patients with a FEDH (10/17 FEDH vs. 11/22 POEDH). Different accompanying intradural lesions occurred in 12 patients of the POEDH subgroup, but only in 2 of the FEDH subgroup (50 vs. 11.8%). However, the presence of such lesions did not significantly deteriorate surgical outcomes in either of the subgroups.
本研究旨在分析额叶硬膜外血肿（FEDH）或枕顶部硬膜外血肿（POEDH）患者之间的差异，并评估可能具有统计学意义的预后因素。
在这项对41例FEDH患者（17例）或POEDH患者（24例）的回顾性研究中，作者分析了性别、年龄、损伤类型、临床表现、入院时格拉斯哥昏迷量表（GCS）评分、影像学检查结果以及从创伤到手术的时间间隔对预后的影响。良好恢复和中度残疾被视为“良好”或“有利结局”，而严重残疾、植物状态或死亡则为“不良结局”。
在POEDH亚组中，入院时较高的GCS评分和较年轻的年龄是预后较好的具有统计学意义的因素（p = 0.006，rs = 0.702）。在FEDH患者亚组中，结果无统计学意义。然而，FEDH患者比POEDH亚组患者更频繁地获得“良好结局”（88.2%对70.9%）。儿童（≤18岁）在POEDH亚组中所占比例（12.5%）低于FEDH亚组（41.2%）。对事故与手术之间时间间隔（≤24小时对>24小时）的评估显示，在任何研究亚组中对结局均无显著影响。然而，受伤后24小时内接受手术的患者入院时GCS评分比受伤后超过24小时接受手术的患者更差。FEDH患者以亚急性和慢性临床病程为主（10/17例FEDH对11/22例POEDH）。POEDH亚组12例患者出现不同的伴随硬膜内病变，而FEDH亚组仅2例（50%对11.8%）。然而，此类病变的存在在任何一个亚组中均未显著恶化手术结局。
