“滑动骨瓣”在小儿开颅手术中的应用29例报告

Application of gliding skull flap in pediatric craniotomy: report of 29 cases

目的探讨“滑动骨瓣”术式应用于儿童开颅手术的可行性。方法术前精确设计骨瓣大小及切口形状,术中使用线锯切下骨瓣,切面呈斜形,不再咬大骨窗。关颅前分离骨窗周边的帽状腱膜下与颅骨骨膜之间隙,将骨瓣埋置于骨窗边帽状腱膜下,在骨瓣相应位置钻2枚小孔,穿入10号丝线,从皮肤切口处引出备牵拉用。缝合头皮,术后5￣7d高颅压消退不需要骨窗减压时,牵拉骨瓣至骨窗处,使之完全复位。结果29例病人均一次复位成功,无一例感染,无并发牵拉部位血肿,骨瓣复位良好,术后半年以上者出现骨性愈合。结论“滑动骨瓣”术式用于儿童开颅手术是安全、有效的,可免去骨瓣减压术后二期颅骨成形术。

Objective To investigate the feasibility of gliding skull flap in pediatric craniotomy.Methods 29 pediatric patients who had underwent craniotomy were retrospectively investigated for the efficacy of the gliding skull valve. The size and form of skull flap were designed correctly before operation. During operation, the skull flap was cut offwith wire saw and the cross-section was oblique. Before closing skull, we separated the space between epicranial aponeurosis and pericranium around the bone window and buried the skull flap under the epicranial aponeurosis with two eyeholes milled in correspon.ding site of skull flap. Through the eyeholes, 10-type thread went out of the skin cut for future pulling the skull flap. 5-7 d after surgery, when intracranial pressure decreased to normal or near normal, the skull flap was pulled by the thread to original place. Results The skull flap in the 29 cases was replaced successfully for the first time without infection and hematoma in operative area postoperatively. The bone union was seen in the edge of skull flap more than half a year after surgery. Conclusion The usage of gliding skull flap is safe, efficacious and satisfactory in pediatric craniotomy and can avoid two-stage cranioplasty.