小儿颅骨凹陷性骨折手术治疗的临床研究

发布时间：2018-10-31 10:08

【摘要】：目的探讨钻孔撬复法和骨瓣开颅复位法两种手术方法在小儿颅骨凹陷性骨折手术治疗中的应用。方法选取自2013年1月至2015年12月吉林大学第一医院神经创伤外科收治的手术治疗小儿颅骨凹陷性骨折的66例患儿资料。其中,男性患儿42例,女性患儿24例,年龄1个月至13岁(平均年龄3.71岁)。从年龄受伤机制、手术方法的选择、术后恢复情况及随访等方面对小儿颅骨凹陷性骨折的手术治疗进行分析。并比较钻孔撬复法(A组,33例)和骨瓣开颅复位法(B组,33例)两种手术方法在小儿颅骨凹陷性骨折手术治疗中的应用。应用χ~2检验及秩和检验进行统计学分析。以P0.05为差异具有统计学意义。结果 66例患儿中,受伤机制以坠落伤和车祸伤为主:其中坠落伤18例(27.3%),车祸18例(27.3%)。按年龄不同将所有66例病例分为1岁、1~6岁和6~13岁组。各组间受伤机制差异有统计学意义(χ~2=15.349,P0.05),坠落伤和打伤在不同年龄段的分布不同,差异有统计学意义(P0.05);1岁组患儿坠落伤发生率明显高于1~6岁组患儿(P0.01)。受伤部位以顶部最多,共31例,其次是颞顶11例和额部10例。笔者对钻孔撬复术和骨瓣开颅复位术两种手术方法的选择进行了比较,两组间患儿在性别上差异无统计学意义(χ~2=2.262,P=0.609)。A组以2岁以内的患儿为主[中位数(四分位数间距):0.92(2.92)];B组以2岁以上的患儿为主[中位数(四分位数间距):5(4.54)],两组的患儿年龄具有明显差异(Z=-3.849,P0.001)。实施钻孔撬复法的平均手术时间为40 min,短于实施开颅复位法(平均时间为1.5 h)。结论小儿颅骨凹陷性骨折如满足以下条件,即2岁,受伤时间2周的,仅仅需要处理骨折,或者仅有少量硬膜外血肿可以从骨孔处清除并且无活动性出血的小儿颅骨凹陷性骨折的患儿,首选钻孔撬复术。
[Abstract]:Objective to explore the application of drilling pry reduction and bone flap craniotomy in the surgical treatment of indented skull fractures in children. Methods from January 2013 to December 2015, 66 children with cranial concave fractures were treated with surgical treatment in the Department of Neurotrauma, the first Hospital of Jilin University. Among them, 42 cases were male and 24 cases were female, aged from 1 month to 13 years (mean age 3.71 years). The surgical treatment of indented skull fracture in children was analyzed from the aspects of age injury mechanism, choice of surgical methods, postoperative recovery and follow-up. The application of two kinds of surgical methods, drilling and prying (group A, 33 cases) and craniotomy and reduction of bone flap (group B, 33 cases) in the surgical treatment of cranial concave fracture in children was compared. 蠂 ~ 2 test and rank sum test were used for statistical analysis. P0.05 as the difference was statistically significant. Results in 66 cases, the injury mechanism was mainly falling injury and accident injury: 18 cases (27.3%) were falling injury, 18 cases (27.3%) were car accident. All 66 cases were divided into 1 year old group, 1 year old group and 6 year old group according to their age. There were significant differences in injury mechanism among groups (蠂 ~ 2 ~ (15.349) P 0.05), and the distribution of falling injury and injury in different age groups were different (P0.05). The incidence of falling injury in 1-year-old group was significantly higher than that in 1-6-year-old group (P0.01). The most common injuries were at the top (31 cases), followed by the temporal parietal (11 cases) and the frontal region (10 cases). The authors compared the two surgical methods of drilling pry reduction and craniotomy. There was no significant difference in sex between the two groups (蠂 ~ 2 = 2.262, 蠂 ~ 2 = 2.262, 蠂 ~ 2 = 2.262, 蠂 ~ 2 = 2.262, 蠂 ~ 2 = 2.262, 蠂 ~ 2 = 2.262, P < 0.05). In the group of 0.609). A, the majority of children were younger than 2 years old [median (quartile spacing): 0.92 (2.92)]; In group B, the majority of children over 2 years old [median (quartile spacing): 5 (4.54)], there was a significant difference in age between the two groups (ZC- 3.849, P0.001). The average operative time of drilling prying method was 40 min, shorter than that of craniotomy (mean time was 1.5 h). Conclusion if the concave fracture of skull in children meets the following conditions: 2 years of age and 2 weeks of injury, only the fracture should be treated. Or only a small amount of epidural hematoma can be removed from the osseous foramen and without active bleeding in children with concave fracture of skull.
【作者单位】：吉林大学第一医院神经创伤外科;吉林大学中日联谊医院神经外科;
【基金】：吉林大学第一医院青年基金项目(20140601)
【分类号】：R726.8

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