不同方法颅底重建治疗开放性颅脑损伤合并前颅窝底粉碎性骨折  

Different methods for the reconstruction of the skull base of open craniocerebral injury combined with comminuted factures of the base of anterior cranial fossa

作　　者：严玉金[1] 李江[1] 王新东[1] 余建军[1] 励勇[1] 管敏武[1] 王慧晓[2] 

机构地区：[1]宁波大学医学院附属医院神经外科,浙江315020 [2]宁波大学医学院附属鄞州人民医院神经外科

出　　处：《中华神经外科杂志》2016年第6期589-592,共4页Chinese Journal of Neurosurgery

摘　　要：目的观察不同方法颅底重建在开放性颅脑损伤合并前颅窝底骨折中的疗效。方法回顾性研究2009年10月至2014年10月宁波大学医学院附属医院和宁波大学医学院附属鄞州人民医院神经外科所收治的46例颅底重建患者的资料，按照颅底重建的方式分成观察组（21例）和对照组（25例）。观察组术中行“三明治法”修补，对照组术中仅用人工脑膜或肌腱膜直接缝合硬膜破口重建。观察两组术后脑脊液漏、颅内感染、脑膜脑膨出及排斥反应等并发症。结果术后随访3—36个月，平均18．5个月。21例观察组患者仅1例发生脑脊液漏，经治疗后痊愈，无颅内感染、脑膜脑膨出等并发症出现，并发症发生率为4．8％（1／21）。对照组25例发生脑脊液漏8例，其中5例合并颅内感染，经治疗后痊愈；脑膜脑膨出2例，并发症的发生率为40．0％（10／25），两组并发症的发生率差异有统计学意义（P〈0．05）。结论对开放性颅脑损伤合并前颅窝底骨折急诊术中行“三明治法”颅底重建，可有效控制术后颅内感染、脑脊液漏等并发症，改善患者的预后。Objective To investigate the efficacy of different methods for reconstruction of the skull base of open craniocerebral injury combined with the base of anterior cranial fossa fracture. Methods The data of 46 patients with skull base reconstruction admitted from October 2009 to October 2014 were studied retrospectively. They were divided into either an observation group （n = 21 ） or a control group （n = 25 ） according to the ways of skull base reconstruction. The observation group was repaired with ＂sandwich＂ therapy ; while the control group only used artificial dura or direct suture of tendon membrane for reconstruction. The complications such as postoperative cerebrospinal fluid leakage, intracranial infection, meningoencephalocele, and reject reaction of both groups were observed. Results The patients were followed up for 3 to 36 months （ mean 15.8）. Of the 21 patients in the observation group, only 1 occurred cerebrospinal fluid leakage. They were cured after treatment. No complications, such as intracranial infection and meningoencephalocele were observed. The incidence of complications was 4. 8% （1/21）. Of the 25 patient in the control group, 8 occurred cerebrospinal fluid leakage, including 5 cases complicated with intracranial infection. They were cured after treatment. Two patients had meningoencephalocele. The incidence of complications was 40.0% （10/25）. There was significant difference in the incidence of complications between the 2 groups （P 〈 0.05）. Conclusion In the emergency operation for open craniocerebral injury combined with the factures of base of anterior cranial fossa, performing ＂sandwich＂ therapy for skull base reconstruction may effectively control the complications, such as intracranial infection and cerebrospinal fluid leakage, and improve the prognosis of patients.

关 键 词：颅底 骨重建 颅骨骨折 颅窝 前 中枢神经系统细菌感染 脑脊液漏 

分 类 号：R651.15[医药卫生—外科学]