외상성 경막하수종의 발생빈도와 양상 및 발생조건에 관한 편향적 조사
A Prospective Study on the Incidence, Patterns and Premorbid Conditions of Traumatic Subdural Hygroma
소속 상세정보
손일태/Il Tae Sohn
이경석/도재원/배학근/윤일규/변박장/Kyeong Seok Lee/Jae Won Doh/Hack Gun Bae/Il Gyu Yun/Bark Jang Byun
KMID : 0359819970260010087
Abstract
결 론
외상성 경막하수종은 두부외상으로 7일 이상 입원한 환자의 35.6%, 외상성 두개강내 종괴
병소의 45.2%를 차지하였고, 특히 40세 이후 두부외상 환자의 54.7%에서 발생하는 매우 흔
한 병소였다. 경막하수종은 81%가 4일 이후 발견되어 지연성 병소로 발생함이 확인되었으
며, 모든 례가 전두부 또는 전두-측두-두정부에 발생하였고, 54.7%가 양측성으로 발생하였
다. 경막하수종은 나이가 많았을 때 더 빨리 발생하였고, 이 차이는 통계학적으로도 유의하
였다(P=0.037).
첫 GT 소견상 동반된 종괴병소가 없을 때, 형태상으로는 단순형일 때, 내원 당시의 GCS
가 9점 이상일 때 반대되는 경우보다 더 빨리 발생하였으나 이 차이는 통계학적으로 유의하
지는 않았다. 위와 같은 발생빈도와 양상을 종합하면, 경막하 수종이 발생하기 위해서는 충
분한 잠재적 경막하강의 존재와 경뇌막 경계세포층의 분리라는 두 가지 소견이 경막하수종
이 발생하기 위한 필요조건이었다 특히 후자보다는 전자가 더 중요한 조건이었고. 경막하강
에 수액이 고이는 기전은 삼출에 의한 것으로 보인다.
두개강내압이 지나치게 낮을 때 잘 발생한다는 점을 고려하면. 노인에 대한 고삼투압 요
법에 주의를 기울여야 하리라본다.
#초록#
The origin and clinical importance of subdural hygroma(SDG) are still uncertain. Its
pathogenetic mechanism and natural history have not yet been settled. Although the
incidence of traumatic SDG has been reported to be 5-20% of posttraumatic
space-occupying lesions, the true incidence has not been documented in prospective
study. Therefore, authors have tried to determine the incidence of traumatic SDG
prospectively during past six months. Serial computed tomograpy(CT) or magnetic
resonance imaging(MRI) studies were done in all patients who were admitted to our
department after head injured. Data on the age, sex, Glasgow coma scale(GCS) on
admission, and initial CT findings were collected and analyzed to determine the true
incidence, pattern and premorbid conditions for the development of traumatic SDG. Serial
CT or MRI scans were performed on the date of admission, the second to sixth hospital
day, and the seventh to fourteenth hospital day. Study population consisted of 115
patients, excluding 31 expired, discharged, or transferred patients within a week.
Subdural hygroma was noted in 42(35.6%) patients. It shared 45.2% of posttraumatic
mass lesion. More than half(54.7%) of patients aged 40 or more had subdural hygromas.
They were generally delayed lesions, due to the fact that most of them(81%) were
observed at four days or more after the injury. All hygromas were located at the frontal
or fronto-temporo-parietal regions. Bilaterality was seen in 54.7%. SDGs occurred earlier
when the age of the patients were 40 years old or more(p=0.037). It occurred earlier
when the initial CT scans were normal, when there was no accompanying traumatic
intracranial lesions, and high GCS on admission. However, these differences were
statistically not significant(p>0.05).
These results suggest that the premorbid conditions for the development of subdural
hygroma were sufficient potential subdural space and separation of the dural border cell
layer, although former seemed to be more important that the later.
Osmotic dehydration in the aged victims should be serially re-evaluated, because the
subdural hygroma may develop when the intracranial pressure is excessively low.
키워드
Epidemiology; Head Injury; Incidence; Mass lesion; Subdural hygroma.;
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