单侧与双侧慢性硬膜下血肿的临床特点分析

目的比较单/双侧慢性硬膜下血肿（chronic subdural hematoma，CSDH）病人临床特点和影像学差异，探讨双侧CSDH的治疗策略。方法回顾性分析57例CSDH病人的临床资料，根据影像学结果将病人分为单侧CSDH组和双侧CSDH组。比较2组病人的临床特点、影像学表现以及复发率差异。根据手术方式不同，将双侧CSDH病人分为双侧手术组和单侧手术组，研究2种手术方式对双侧CSDH病人复发率的影响。结果2组病人肌力下降、头晕头痛、语言障碍、癫痫、意识障碍、颅脑损伤、使用抗凝/抗血小板药物和复发率差异均无统计学意义（P>0.05）；单侧CSDH组术前CT中线移位平均距离高于双侧CSDH组，血肿厚度单侧低于双侧（P < 0.01）。双侧CSDH病人中行双侧钻孔引流术病人的平均最大血肿厚度高于单侧手术病人（P < 0.05）；双侧手术治疗组中线移位平均距离、复发率与单侧手术治疗病人差异无统计学意义（P>0.05）。结论单、双侧CSDH具有不同的影像学特点，部分双侧CSDH病人可以通过一侧钻孔引流获得治愈。

Analysis of the clinical characteristics of unilateral and bilateral chronic subdural hematoma

ObjectiveTo compare the clinical features and imaging differences between unilateral and bilateral chronic subdural hematoma(CSDH), and investigate the treatment strategies of bilateral CSDH.MethodsThe clinical data of 57 pateints with CSDH were retrospectively analyzed, and divided into the unilateral CSDH group and bilateral CSDH group according to CT scan findings.The clinical characteristics, imaging findings and recurrence rate between two groups were compared.The bilateral CSDH patients were subdivided into the bilateral operation group and unilateral operation group according to different surgical methods, and the recurrence rate between two group was analyzed.ResultsThe differences of the muscle weakness, dizziness, headache, language disorder, epilepsy, consciousness disorder, brain injury, use of anticoagulant/antiplatelet drugs and recurrence rate between two groups were not statistically significant(P>0.05).The mean distance of CT midline shift in unilateral CSDH group was higher than that in bilateral CSDH group, and the thickness of hematoma was lower in unilateral CSDH group than that in bilateral CSDH group(P < 0.01).The average maximum hematoma thickness in bilateral CSDH patients treated with bilateral drilling drainage was higher than that in unilateral operation patients(P < 0.05).There was no statistical significance in the mean distance of midline shift and recurrence rate between bilateral operation group and unilateral operation group(P>0.05).ConclusionsThe imaging characteristics bewteen unilateral and bilateral CSDH are different.Some patients with bilateral CSDH can be cured by unilateral drilling drainage.