超颌面骨折一期整复联合开颅手术对中型颅脑损伤治疗意义的探讨  

Maxillofacial Osseous Reconstruction in One-stage Operation Combined with Craniotomy for Moderate Craniocerebral Injury

作　　者：王娟[1] 王君红 赵继元[3] 李瑞春[1] 

机构地区：[1]西安交通大学第一附属医院神经外科,西安710061 [2]西安市户县医院神经外科 [3]西安交通大学第一附属医院耳鼻喉科

出　　处：《华西医学》2015年第10期1857-1861,共5页West China Medical Journal

摘　　要：目的探讨中型颅脑损伤合并颌面创伤患者一期开颅联合颌面整复手术的意义。方法回顾性分析2008年1月-2015年2月收治的13例中型颅脑损伤患者的临床和影像资料。以入院时间2008年1月-2009年12月7例患者为对照组,男5例,女2例,年龄22～66岁,平均（44.3±15.9）岁;入院后24 h内实施开颅清创术,3～5周后行二期颌面整形手术治疗。以入院时间2010年1月-2015年2月的6例患者为观察组,男4例,女2例,年龄27～57岁,平均（40.2±10.7）岁;入院后24 h内行一期开颅清创联合颌面整复手术治疗。分析比较两组的治疗效果、脑脊液漏、颅内感染和平均住院时间。结果对照组术前脑脊液鼻漏5例,一期开颅术后脑脊液漏均消失;在二期颌面整复术中发现骨痂、组织瘢痕形成,3例整复效果欠佳,其中2例再次出现脑脊液鼻漏,7～14 d后治愈;平均住院时间（43.4±4.5）d。观察组术前脑脊液鼻漏3例,其中1例联合术后仍有脑脊液漏,7 d后治愈;平均住院时间（22.7±2.7）d。两组患者均无术后颅内感染。结论中型颅脑损伤合并颌面创伤患者实施开颅手术联合一期颌面重建,对患者预后和缩短住院时间都有积极意义。Objective To explore the value of maxillofacial osseous reconstruction in one-stage operation combined with craniotomy for moderate craniocerebral injury. Methods A retrospective study was conducted by analyzing the clinical and radiographic results of 13 patients treated between January 2008 and February 2015. Among them, 7 patients admitted into the hospital between January 2008 and December 2009 were regarded as the control group. Among the 7 patients, 5 were males and 2 were females, aged between 22 and 66 years old, averaging（44.3±15.9） years old. The patients of the control group underwent craniotomy within 24 hours after admission, and accepted the second stage operation for maxillofacial reconstruction 3 to 5 weeks later. The other 6 patients including 4 males and 2 females aged between 27 and 57 years old, averaging（40.2±10.7） years old, admitted into the hospital between January 2010 and February 2015 were designated into the observation group. They underwent maxillofacial osseous reconstruction in onestage operation combined with craniotomy within 24 hours after admission. The treatment effect, leakage of cerebrospinal fluid, intracranial infection and average length of stay were analyzed and compared. Results In the control group, there were 5 cases of cerebrospinal rhinorrhea preoperatively, and all were cured after craniotomy. During the second stage operation for maxillofacial reconstruction, bone callus and scar tissue presented in all cases and poor reconstruction occurred to 3 cases. After reconstruction, cerebrospinal rhinorrhea recurred in 2 cases. The average length of stay was（43.4±4.5） days. For the observation group there were 3 cases of cerebrospinal rhinorrhea preoperatively, and one of them remained after the operation and cured 7 days later. The average length of stay was（22.7±2.7） days. None of the 13 patients suffered intracranial infection. Conclusion Maxillofacial osseous reconstruction should be considered in one-stage operation combined with craniotomy for mod

关 键 词：颅脑损伤 颌面整复 脑脊液漏 

分 类 号：R651.15[医药卫生—外科学]