Slasky Shira E, Rivaud Yayone, Suberlak Matthew, Tairu Oluwole, Fox Adam D, Ohman-Strickland Pamela, Bilinisky Esther
From the Departments of *Radiology and †Trauma Surgery, New Jersey School of Medicine, Rutgers, The State University of New Jersey, Newark; and ‡Rutgers School of Public Health, RWJ-School of Public Health, Piscataway, NJ.
J Comput Assist Tomogr. 2017 Nov/Dec;41(6):891-897. doi: 10.1097/RCT.0000000000000620.
The aim of our study was to determine the incidence and risk factors of dural venous sinus thrombosis and epidural hemorrhage in the setting of a blunt trauma causing a calvarial fracture crossing a dural venous sinus.
A retrospective review of 472 blunt trauma patients with calvarial fracture crossing a dural venous sinus was performed. Two hundred ten patients who underwent computed tomography venography were identified and evaluated for the presence of dural venous sinus thrombosis and/or epidural hemorrhage. Site and displacement of fractures, as well as age, sex, Glasgow Coma Scale (GCS) score, and mechanism of injury, were considered for potential predictive value of thrombosis and/or epidural hemorrhage.
We found a 23% incidence of dural venous sinus thrombosis in patients with a fracture traversing a dural venous sinus. Significant predictors of thrombosis included temporal fracture (38% incidence) and skull base fracture (31% incidence). Occipital fracture not involving the skull base was associated with a significantly decreased risk of thrombosis, with an incidence of 9%. Decreased GCS score and fall from height greater than 10 feet additionally predicted dural venous sinus thrombosis. Significant predictors of epidural hemorrhage included parietal fractures and displaced fractures, although a large percentage of nondisplaced fractures in other bones demonstrated epidural hemorrhage as well.
Dural venous sinus thrombosis in the setting of blunt trauma with a calvarial fracture crossing a dural venous sinus has an incidence of 23%. Increased suspicion for thrombosis is warranted in patients with temporal or skull base fractures, low GCS score, and recent fall from great height.
我们研究的目的是确定在钝性创伤导致颅骨骨折横跨硬脑膜静脉窦的情况下，硬脑膜静脉窦血栓形成和硬膜外出血的发生率及危险因素。
对472例颅骨骨折横跨硬脑膜静脉窦的钝性创伤患者进行回顾性研究。确定了210例行计算机断层扫描静脉造影的患者，并评估是否存在硬脑膜静脉窦血栓形成和/或硬膜外出血。考虑骨折的部位和移位情况，以及年龄、性别、格拉斯哥昏迷量表（GCS）评分和损伤机制，以判断其对血栓形成和/或硬膜外出血的潜在预测价值。
我们发现骨折横跨硬脑膜静脉窦的患者中硬脑膜静脉窦血栓形成的发生率为23%。血栓形成的显著预测因素包括颞骨骨折（发生率38%）和颅底骨折（发生率31%）。不累及颅底的枕骨骨折与血栓形成风险显著降低相关，发生率为9%。GCS评分降低和从高于10英尺的高度坠落也可预测硬脑膜静脉窦血栓形成。硬膜外出血的显著预测因素包括顶骨骨折和移位骨折，尽管其他骨骼中很大比例的无移位骨折也出现了硬膜外出血。
钝性创伤导致颅骨骨折横跨硬脑膜静脉窦时，硬脑膜静脉窦血栓形成的发生率为23%。对于颞骨或颅底骨折、GCS评分低以及近期从高处坠落的患者，应提高对血栓形成的怀疑。
