儿童颅面穿通性损伤的治疗  

The clinical classification,diagnosis and treatment of craniofacial penetrating injuries in children

作　　者：田道锋[1] 邹瑛[1] 陈谦学[1] 陈治标[1] 刘仁忠[1] 叶应湖[1] 王国安[1] 

机构地区：[1]武汉大学人民医院神经外科,430060

出　　处：《临床外科杂志》2008年第10期676-677,共2页Journal of Clinical Surgery

摘　　要：目的探讨儿童颅面穿通性损伤的临床表现及治疗原则。方法对23例儿童颅面穿通性损伤采用早期彻底清创Ⅰ期修复术。结果恢复良好者13例,轻残4例,重残3例,死亡3例。面容满意7例,基本满意9例,瘢痕挛缩3例,塌陷(去骨板减压)l例。14例脑脊液漏术后2～27d停止,1例经再次手术治愈。随访6个月～11年未见癫痫发作,无一例发生颅内感染和创面局部伤口感染。结论经眶部穿通伤是颅面穿通伤的最常见类型;儿童颅面穿通性损伤死亡和残废率高,救治难度大,应重视病史及生命体征变化,妥善处理脑损伤,尽早彻底清创Ⅰ期手术修复。Objective To study the clinical feature,the diagnosis and treatment of craniofacial penetrating injuries. Methods Twenty - three cases of craniofacial penetrating injuries in children which were treated in our hospital between Jan. 1988 to Jan. 2008 were studied retrospectively. The patients ranged in age from 1.5 to 18.0 years, with a mean age of 10.4 years. Results Thirteen cases recovered well. There were 4 cases of mild disability, 3 cases of moderate disability and 3 deaths. The aesthetic and functional results were satisfactory in 16 cases, facial cicatricial contracture in 3 cases, and maxillofacial skeleton collapsed in 1 case. Among the patients with cerebrospinal fluid （CSF） leakage, 14 cases were cured postoperation, and 1 case received re - operation and cured. There were no epilepsy, intracranial infection and wound infection during the follow - up period of 6 months to 11 years. Conclusion Transorbital penetrating craniocerebral injuries are the most common type of eraniofacial penetrating injuries. The mortality and the disability rate of craniofacial penetrating injuries are high. It is very important to think highly of medical record and the change of vital signs.

关 键 词：颅面穿通伤 临床特征 诊断 治疗 儿童 

分 类 号：R726.5[医药卫生—儿科]