小儿外伤性幕上硬膜外血肿的保守治疗
Conservative Management of Large Traumatic Supratentorial Epidural Hematoma in the Pediatric Population.
作者信息
Champagne Pierre-Olivier, He Kevin Xiaho, Mercier Claude, Weil Alexander G, Crevier Louis
机构信息
Division of Pediatric Neurosurgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
出版信息
Pediatr Neurosurg. 2017;52(3):168-172. doi: 10.1159/000455925. Epub 2017 Mar 23.
BACKGROUND/AIMS: Conservative management of traumatic epidural hematomas is being recognized as a safe alternative to surgical treatment in asymptomatic children. There is still debate about the maximal size of epidural hematoma that should be tolerated before deciding for surgery.
METHODS
We report - through a retrospective cohort study from a single institution - a series of 16 conservatively managed traumatic epidural hematomas of more than 15 mm thickness.
RESULTS
14 patients (88%) were successfully treated using conservative management. Two patients required surgery. These 2 patients had the only 2 documented high-velocity injury mechanisms. All patients had a Glasgow Outcome Scale of 5/5 on follow-up.
CONCLUSION
Conservative management with close observation is a safe alternative even in this population of voluminous hematomas. Injury velocity may be a contributing factor for failure of conservative management in this population.
背景/目的：对于无症状儿童外伤性硬膜外血肿，保守治疗正被视为手术治疗的一种安全替代方法。在决定是否进行手术之前，硬膜外血肿的最大可耐受尺寸仍存在争议。
方法
我们通过一项来自单一机构的回顾性队列研究，报告了一系列厚度超过15毫米且采用保守治疗的外伤性硬膜外血肿病例。
结果
14例患者（88%）通过保守治疗成功治愈。2例患者需要手术治疗。这2例患者是仅有的2例记录有高速损伤机制的病例。所有患者随访时格拉斯哥预后评分均为5分（满分5分）。
结论
即使对于这类大量血肿的患者，密切观察下的保守治疗也是一种安全的替代方法。损伤速度可能是该人群保守治疗失败的一个影响因素。
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