儿童颞骨骨折临床特点和治疗策略  

Clinical characteristics and management of pediatric temporal bone fractures

作　　者：马宁[1,2] 陈敏 刘薇[1,2] 杨扬 邵剑波[1,2] 郝津生 刘冰[1,2] 张晓 段晓岷 张祺丰[3] 张杰 MA Ning;CHEN Min;LIU Wei;YANG Yang;SHAO Jianbo;HAO Jinsheng;LIU Bing;ZHANG Xiao;DU AN Xiaomin;ZHANG Qifeng;ZHANG Jie(Department of Otorhinolaryngology&Head and Neck Surgery,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China;Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery,Beijing 100045,China;Department of Radiology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心/首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京100045 [2]儿童耳鼻咽喉头颈外科疾病北京市重点实验室,北京100045 [3]国家儿童医学中心/首都医科大学附属北京儿童医院影像中心,北京100045

出　　处：《山东大学耳鼻喉眼学报》2022年第1期13-19,共7页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：北京市医院管理中心儿科学科协同发展中心专项经费资助(XTYB201828);北京市医院管理中心“登峰”计划(DFL20191201)。

摘　　要：目的 探讨儿童颞骨骨折的临床特点及治疗策略。方法 回顾性分析2014年7月~2021年7月首都医科大学附属北京儿童医院确诊的477例18岁以下颞骨骨折患儿的临床资料,包括患儿性别、年龄、受伤原因、影像学、面神经及听力学评估、并发症、治疗及预后。结果 477例颞骨骨折患儿中男358例、女119例,男女比例为3∶1,年龄范围为0~18岁,中位年龄9岁,其中6例为双侧。交通事故是受伤主要原因(57.23%),其次为跌倒(23.69%)。最常见的临床症状为鼓室积血和耳出血,通常3周~1个月消失。纵行骨折253耳(52.38%),横行骨折35耳(7.25%),混合型骨折48耳(9.93%),其他不能进行分型147耳(30.43%),表现为轻微骨折线。听力受损372例(77.02%);面神经损伤28例(5.80%),其中8例为内听道及以上层面损伤;脑脊液耳漏47例(9.73%);鼓膜穿孔15例(3.11%)。合并颅内损伤78例(16.35%),全身多发损伤19例(3.98%)。即发性面瘫10例,1例恢复良好(10.00%);迟发性面瘫18例,15例恢复良好(83.33%)。耳科并发症的处理经手术治疗10例,包括8例鼓室探查+听骨链重建,术后听阈恢复正常。2例面神经减压术,术后House-Brackmann面神经功能分级(HB分级)Ⅴ级恢复至Ⅱ级。结论 儿童颞骨骨折中,男童常见,最常见的受伤原因为交通事故。鼓室积血、鼓膜穿孔、脑脊液耳漏和传导性耳聋经保守治疗多可治愈,外伤所致听骨链骨折或脱位经手术治疗预后良好,外伤所致内听道区域骨折可引起极重度感音神经性耳聋和完全性面瘫,预后较差。Objective To summarize the clinical characteristics and treatment strategies of temporal bone fracture in children. Methods Medical records of 477 children under 18 years old who were diagnosed with temporal bone fracture in Beijing Children?s Hospital from July 2014 to July 2021 were retrospectively analyzed. Including age, gender, injury causes, imaging, facial nerve and audiological assessment, complications, treatment and prognosis. Results 483 sides of 477 children, 6 of which were bilateral. The age range was from birth to 18 years old, the median age was 9 years old, and the male to female ratio was 3.01∶1. Traffic accidents were the main cause of injuries, accounting for 57.23%, followed by falls, accounting for 23.69%. The most common clinical symptoms are tympanema and ear hemorrhage, which usually disappear from 3 weeks to 1 month. Longitudinal fracture accounted for 52.38%, transverse fracture 35, 7.25%;48 cases of mixed fracture, accounting for 9.93%, and 147 cases, accounting for 30.43%, which could not be classified, were presented as minor fracture lines.372 cases(77.02%) had hearing impairment. Facial nerve injury occurred in 28 cases(5.80%), including 8 cases of internal auditory canal injury. Cerebrospinal fluid otorrhea(CSF) was found in 47 cases(9.73%). Tympanic membrane perforation occurred in 15 cases(3.11%). 6.35% with intracranial injury. 3.98% complicated with multiple fractures or multiple organ injuries. There were 10 cases of immediate facial paralysis, 1 case recovered well, accounting for 10.00%, and 18 cases of delayed facial paralysis, 15 cases recovered well, accounting for 83.33%. 10 cases were treated by operation, including 8 cases of tympanum exploration and ossicular chain reconstruction. Facial nerve HB Ⅴ was recovered to HB Ⅱafter decompression in 2 cases. Conclusion Temporal bone fracture in children is most common in boys, and the most common cause of injury is traffic accident. Tympanic hemorrhage, tympanic membrane perforation, cerebrospinal fluid otorrhea and co

关 键 词：颞骨骨折 儿童 面神经损伤 听力损失 脑脊液耳漏 

分 类 号：R764.3[医药卫生—耳鼻咽喉科]