【摘要】：目的探討鉆孔撬復(fù)法和骨瓣開(kāi)顱復(fù)位法兩種手術(shù)方法在小兒顱骨凹陷性骨折手術(shù)治療中的應(yīng)用。方法選取自2013年1月至2015年12月吉林大學(xué)第一醫(yī)院神經(jīng)創(chuàng)傷外科收治的手術(shù)治療小兒顱骨凹陷性骨折的66例患兒資料。其中,男性患兒42例,女性患兒24例,年齡1個(gè)月至13歲(平均年齡3.71歲)。從年齡受傷機(jī)制、手術(shù)方法的選擇、術(shù)后恢復(fù)情況及隨訪等方面對(duì)小兒顱骨凹陷性骨折的手術(shù)治療進(jìn)行分析。并比較鉆孔撬復(fù)法(A組,33例)和骨瓣開(kāi)顱復(fù)位法(B組,33例)兩種手術(shù)方法在小兒顱骨凹陷性骨折手術(shù)治療中的應(yīng)用。應(yīng)用χ~2檢驗(yàn)及秩和檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)分析。以P0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果 66例患兒中,受傷機(jī)制以墜落傷和車(chē)禍傷為主:其中墜落傷18例(27.3%),車(chē)禍18例(27.3%)。按年齡不同將所有66例病例分為1歲、1~6歲和6~13歲組。各組間受傷機(jī)制差異有統(tǒng)計(jì)學(xué)意義(χ~2=15.349,P0.05),墜落傷和打傷在不同年齡段的分布不同,差異有統(tǒng)計(jì)學(xué)意義(P0.05);1歲組患兒墜落傷發(fā)生率明顯高于1~6歲組患兒(P0.01)。受傷部位以頂部最多,共31例,其次是顳頂11例和額部10例。筆者對(duì)鉆孔撬復(fù)術(shù)和骨瓣開(kāi)顱復(fù)位術(shù)兩種手術(shù)方法的選擇進(jìn)行了比較,兩組間患兒在性別上差異無(wú)統(tǒng)計(jì)學(xué)意義(χ~2=2.262,P=0.609)。A組以2歲以內(nèi)的患兒為主[中位數(shù)(四分位數(shù)間距):0.92(2.92)];B組以2歲以上的患兒為主[中位數(shù)(四分位數(shù)間距):5(4.54)],兩組的患兒年齡具有明顯差異(Z=-3.849,P0.001)。實(shí)施鉆孔撬復(fù)法的平均手術(shù)時(shí)間為40 min,短于實(shí)施開(kāi)顱復(fù)位法(平均時(shí)間為1.5 h)。結(jié)論小兒顱骨凹陷性骨折如滿足以下條件,即2歲,受傷時(shí)間2周的,僅僅需要處理骨折,或者僅有少量硬膜外血腫可以從骨孔處清除并且無(wú)活動(dòng)性出血的小兒顱骨凹陷性骨折的患兒,首選鉆孔撬復(fù)術(shù)。
[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.
【作者單位】： 吉林大學(xué)第一醫(yī)院神經(jīng)創(chuàng)傷外科;吉林大學(xué)中日聯(lián)誼醫(yī)院神經(jīng)外科;
【基金】：吉林大學(xué)第一醫(yī)院青年基金項(xiàng)目(20140601)
【分類(lèi)號(hào)】：R726.8

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