颅底骨折综合伤情判定及其临床意义

The integrated injury evaluation of skull base fracture and its clinical significance

目的探讨颅底骨折临床综合伤情的评估。方法从颅底(B)结构的完整性、颅脑(C)损伤程度、颅面以外远处(D)器官与组织的损伤程度三个方面来界定颅底骨折的损伤程度与病情,以此评估187例颅底骨折病人的损伤程度与病情。结果全组187例颅底骨折病人被分为四期。临床Ⅰ期:47例,治愈43例(43/47,91.5%),好转3例(3/47,6.4%),未治1例(1/47,2.1%);临床Ⅱ期:62例,治愈57例(57/62,91.9%),好转5例(5/62,8.1%);临床Ⅲ期:43例,全部治愈;临床Ⅳ期:35例,治愈21例(21/35,60%),死亡14例(14/35,40%)。全组14例死亡病人均属C3级与临床Ⅳ期,造成死亡的主要原因是颅脑挫裂伤或颅内出血引发的呼吸与循环衰竭。结论BCD伤情参数设置合理,可全面有效地判定颅底骨折的损伤程度与临床病情。当B参数提高时颅底结构的损伤程度逐步加重;C参数提高时则颅底骨折的颅脑损伤程度逐步加重,临床病情愈趋复杂凶险,死亡病例多为C3级;D参数提高时则颅面以外远处器官与组织的损伤程度加重。

Objective To explore the integrated injury evaluation of skull base fracture and its clinical significance. Methods The injury degree and clinical situation were defined and evaluated by the integrity of skull base, the cerebral injury and the injury degree of the distant organs and tissue beyond cranial face. One hundred and eighty-seven cases of skull base fracture were evaluated and analyzed. Results All cases were divided into four clinical stages. For 47 cases in clinical stage Ⅰ, 43 were cured （43/47, 91.5%）, 3 were improved （3/47, 6.4%）, 1 refused treatment （1/47, 2.1%）. For62 in clinical stage Ⅱ, 57 were cured （57/62, 91.9%）, 5 were improved （5/62, 8.1%）. Forty-three cases in clinical period Ⅲ were all cured. For 35 cases in clinical stage Ⅳ, 21 cases were cured （21/35, 60 % ）, 14 cases died （14/35, 40%）. All dead cases belonged to C3 type and clinical stage Ⅳ, in which failure of respiration and circulation was induced by cranial bleeding and cerebral injury. Conclusion This novel classification of skull base fracture is scientific and reasonable. The type classification can effectively evaluate the injury degree of skull base fracture and the stage classification can effectively evaluate the clinical situation of skull base fracture. The injury degree of skull base structures increases with the increase of scale of B type. The cerebral injury degree of skull base fracture increases with the increase of scale of C type, which indicates more complicated and dangerous clinical situation. The injury degree of the distant organs and tissues beyond cranial face increases.