Stone J L, Rifai M H, Sugar O, Lang R G, Oldershaw J B, Moody R A
Surg Neurol. 1983 Mar;19(3):216-31. doi: 10.1016/s0090-3019(83)80005-6.
A series of 206 patients with clotted subdural hematomas operated within 3 days of closed head injury is presented. Sixty-two percent (128) were operated within 24 hours of trauma (acute subdural hematoma) carrying a high incidence of sterotypic motor posturing, impaired oculomotor reflexes, and unilateral dilated fixed pupil. A functional recovery occurred in 27% and a vegetative state or death resulted in 62%. The remaining 38% were operated after 24 but within 72 hours from injury (early subacute subdural hematoma) and generally had less severe neurologic dysfunction. A functional recovery occurred in 54% and vegetative state or death in 34%. The 128 acute cases are presented in detail to establish a logical basis for time differential. The cases requiring operation within 12 hours of injury were the most challenging. Improved outcome is felt to result from prompt referral and large craniotomy in the earliest hours after injury, combined with careful postoperative monitoring. Clinical, operative and autopsy findings are presented and discussed in relation to pathogenesis.
本文报告了206例在闭合性颅脑损伤后3天内接受手术治疗的硬膜下血肿凝固患者。62%（128例）在创伤后24小时内接受手术（急性硬膜下血肿），其刻板运动姿势、动眼神经反射受损和单侧瞳孔散大固定的发生率很高。27%的患者功能恢复，62%的患者进入植物状态或死亡。其余38%在受伤后24小时至72小时内接受手术（早期亚急性硬膜下血肿），通常神经功能障碍较轻。54%的患者功能恢复，34%的患者进入植物状态或死亡。详细介绍了128例急性病例，以建立时间差异的逻辑基础。受伤后12小时内需要手术的病例最具挑战性。认为及时转诊、在受伤后最早时间进行大骨瓣开颅手术以及术后仔细监测可改善预后。本文展示并讨论了与发病机制相关的临床、手术和尸检结果。
