Soud Lek. 2020 Winter;65(4):79-83.
The primary aim is to analyze the relationship between the reasons for reoperation after surgery for acute subdural hematoma and the injury mechanism and secondarily the relationship between the acute subdural hematoma primarily operated on and the area of reoperation.
Among adult patients operated on for acute subdural hematoma between 2013 and 2017, patients reoperated within 14 days were identified. Injury mechanisms, reasons for reoperation, and reoperated lesion location were studied.
Of 86 patients operated on for acute subdural hematoma, 24 patients were reoperated (27.9%). The main indications for reoperation after uncomplicated falls as injury cause (12 patients) were recurrent/significant residual subdural hematoma (7 patients) and contralateral subdural hematoma (3 cases). In complicated falls (long staircase, 3 patients), the reasons for reoperation were expansive intraparenchymal hematoma or brain contusion. In traffic accidents (4 patients, 3 pedestrians hit by cars), the reason for reoperations was brain contusion (two cases), contralateral intracerebral and subdural hematoma and postoperative epidural hematoma. Injury mechanism was unknown in 5 patients. In 20.8% of reoperations, the reoperated lesion (mainly subdural hematoma) was contralateral to the primary subdural hematoma. Prognosis was worse in reoperated patients.
Recurrent/significant residual subdural hematomas are the most frequent reasons for reoperation after acute subdural hematoma surgery. The reasons for reoperations are related to the mechanism of injury. Simple falls are associated mainly with recurrent/significant residual or contralateral subdural hematomas. In complicated falls or traffic accidents (vigorous injuring force) hemorrhagic injuries of the brain parenchyma prevail.
主要目的是分析急性硬膜下血肿手术后再手术的原因与损伤机制之间的关系，次要目的是分析首次手术治疗的急性硬膜下血肿与再次手术部位之间的关系。
在 2013 年至 2017 年间接受急性硬膜下血肿手术的成年患者中，确定了 14 天内再次手术的患者。研究了损伤机制、再手术的原因和再手术的病变部位。
在 86 例接受急性硬膜下血肿手术的患者中，有 24 例（27.9%）再次手术。无并发症跌倒导致损伤的主要再手术指征（12 例）为复发性/显著残留硬膜下血肿（7 例）和对侧硬膜下血肿（3 例）。在复杂跌倒（长楼梯，3 例）中，再手术的原因是脑实质内血肿扩展或脑挫裂伤。在交通事故（4 例，行人被汽车撞 3 例）中，再手术的原因是脑挫裂伤（2 例）、对侧脑内和硬膜下血肿以及术后硬膜外血肿。5 例患者的损伤机制不明。在 20.8%的再手术中，再手术的病变（主要是硬膜下血肿）位于首次硬膜下血肿的对侧。再手术患者的预后较差。
急性硬膜下血肿手术后再手术的最常见原因是复发性/显著残留硬膜下血肿。再手术的原因与损伤机制有关。单纯跌倒主要与复发性/显著残留或对侧硬膜下血肿有关。在复杂跌倒或交通事故（剧烈致伤力）中，脑实质出血损伤更为常见。
