外伤性额窦骨折合并脑脊液漏的经颅手术治疗  

Craniotomy in traumatic frontal sinus fracture cerebrospinal fluid leaks

作　　者：邓永嘉 罗成义[2] 刘建平 柳婷 黄伟超 

机构地区：[1]佛山市南海区第六人民医院神经外科,广东省佛山528248 [2]南方医科大学珠江医院神经外科,广东省广州510280

出　　处：《中国基层医药》2016年第6期904-907,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨外伤性额窦骨折合并脑脊液漏的经颅手术治疗。方法回顾2010年1月至2014年12月收治的、经保守治疗无效选择手术的外伤性额窦骨折合并脑脊液漏的12例患者的临床资料。术前通过典型的临床表现结合颅底薄层CT扫描确诊及定位，手术采用双侧冠状切口，经颅硬膜外径路，术中主要对硬脑膜、颅骨两层面进行处理，对额窦壁骨性缺损以骨水泥修补，以带蒂骨膜瓣作覆盖，硬脑膜缺损以自体筋膜瓣修补，术后卧床休息、应用抗生素7～14d、甘露醇或视情况选择腰大池引流等措施。结果12例患者术前CT均有提示额窦骨质缺损，行经颅手术治疗，均1次手术修补成功，未发生颅内感染，1例出现嗅觉丧失。术后随访3～12个月，脑脊液漏未见复发。结论对于外伤性额窦骨折合并脑脊液漏的患者，保守治疗无效，实行经颅冠状切口手术修补，通过分别对硬脑膜及颅骨两层面的处理，能取得满意效果。Objective To assess the craniotomy in traumatic frontal sinus fracture cerebrospina! fluid（CSF） leaks. Methods Clinical data of 12 traumatic frontal sinus fracture CSF leaks from January 2010 to December 2014, who treated by craniotomy and conservation treatment was invalid were reviewed. Combined typical clinical presentation and basicranial thin -layer computed tomography （CT）, made qualitative diagnosis and localization. Craniotomy by bilateral coronary incision and epidural approach was performed. Repairation was mainly for the endocranium and the basieranium. Bone cement was used to reconstruct the osseous defect of the frontal sinus, and then with pedicle periosteal flap coverage. Dural defects was fixed with autogenous fascia. After operation, staying in bed and Using anti- biotic for 7 - 14 days were required,while mannital or lumbar - drainage as needed. Results All 12 cases got positive preoperative CT results. Craniotomy was performed, succeeded without reoperation. None of intracranial infection happened,while 1 case suffered from anosphrasia. Followed up for 3 - 12 months, none CSF leaks relapsed. Conclusion Craniotomy by coronary incision, dispose the endocranium and the basicranium for the patients who suffered from frontal sinus fracture CSF leaks while conservation treatment is invalid, can obtain satisfied result.

关 键 词：外伤性额窦骨折 脑脊液漏 经颅硬膜外径路 

分 类 号：R651.1[医药卫生—外科学]