外伤性颅底骨折所致脑脊液漏的处理及预后因素分析

发布时间：2018-04-04 23:06

本文选题：颅脑外伤　切入点：颅底骨折　出处：《国际神经病学神经外科学杂志》2017年03期

【摘要】：目的分析影响外伤性颅底骨折所致脑脊液漏愈合的相关因素,以探索外伤性脑脊液漏更好的治疗策略。方法回顾性分析2000年2月至2009年4月期间收治的外伤后颅底骨折所致的脑脊液漏患者的临床资料,收集患者基本信息,入院时GCS评分,脑脊液漏的类型(鼻漏、耳漏)、治疗方式(保守治疗、腰大池引流、手术),有无颅内感染、脑脊液漏预后状况等相关临床资料,采用SPSS软件统计分析可能影响脑脊液漏愈合的相关因素。结果 83例脑脊液漏患者中,男性患者55名,女性患者28名,年龄16~73岁,平均43.8±17.3岁。其中11例患者因颅内合并伤(颅内血肿、神经损伤等)、广泛性颅底骨折、严重的脑脊液漏等行急诊手术治疗,39例患者采用保守治疗脑脊液漏愈合,31例采用腰大池置管引流愈合,2例经保守观察及腰大池引流治疗后仍未治愈行开颅手术修补后愈合。治疗效果满意,无死亡病例,仅1例颅内感染病例。影响脑脊液漏愈合相关因素包括:患者年龄、入院时GCS评分、脑脊液漏的类型。结论多数外伤性脑脊液漏经保守治疗或腰大池置管引流治疗后可愈合,因合并伤需要手术、颅骨广泛性骨折、脑脊液漏严重者需尽早手术治疗。
[Abstract]:Objective to analyze the factors influencing the healing of cerebrospinal fluid leakage caused by traumatic skull base fracture, and to explore the better treatment strategy of traumatic cerebrospinal fluid leakage.Methods the clinical data of patients with cerebrospinal fluid leakage caused by traumatic skull base fracture from February 2000 to April 2009 were analyzed retrospectively. The basic information of the patients, the GCS score on admission and the type of cerebrospinal fluid leakage (rhinorrhea) were collected.The related clinical data such as conservative treatment, lumbar cistern drainage, surgical operation, intracranial infection and cerebrospinal fluid leakage prognosis were analyzed by SPSS software.Results among 83 patients with cerebrospinal fluid leakage, 55 were male and 28 were female. The age was 1673 years (mean 43.8 卤17.3 years).Among them, 11 patients suffered from extensive skull base fracture due to intracranial combined injury (intracranial hematoma, nerve injury, etc.)Severe cerebrospinal fluid leakage and other emergency operations were performed in 39 patients with acute cerebrospinal fluid leakage. 31 patients with cerebrospinal fluid leakage union were cured by lumbar cistern drainage and 2 patients were treated with conservative observation and lumbar cistern drainage treatment, which were still not healed after craniotomy and repair.There were no death cases and only one case of intracranial infection.Factors related to cerebrospinal fluid leakage healing included age, GCS score at admission, and type of CSF leakage.Conclusion most traumatic cerebrospinal fluid leakage can heal after conservative treatment or drainage of lumbar cistern. Surgical treatment is needed as soon as possible for complicated injury, extensive skull fracture and severe cerebrospinal fluid leakage.
【作者单位】：河南省邓州市人民医院神经外科;
【分类号】：R651.15

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