前颅窝严重粉碎性骨折患者颅底骨性重建的意义

Clinical significance of bone reconstruction at cranial base for traumatic comminuted fractures of anterior skull base

目的探讨创伤性前颅窝底严重粉碎性骨折所致颅底缺损骨性重建的临床意义。方法将46例颅底缺损患者采用随机数字表法分成观察组与对照组两组，每组23例。观察组术中进行骨性颅底重建及膜性重建，对照组仅进行膜性重建。术后进行为期6个月至1年的临床随访，并行头颅CT或MRI检查，观察有无脑脊液漏、颅内感染及脑膜脑膨出等情况。结果观察组18例存活患者仅发生1例轻度脑脊液漏，经治疗治愈：对照组17例发生脑脊液漏5例，其中并发颅内感染3例，脑膜脑膨出3例（其中1例3种并发症均有）。两组总并发症发生比例分别为1／18、5／17。观察组并发症发生比例低于对照组（P〈0．05）。结论对创伤性前颅窝底严重粉碎性骨折所致颅底缺损患者术中进行骨性颅底重建，可有效防治脑脊液漏、颅内感染及脑膜脑膨出等。

Objective To study the clinical significance of bone reconstruction at cranial base for severe traumatic comminuted fractures of anterior skull base. Methods Forty-six bone defect cases were divided into treatment group and control group randomly. Treatment group was treated with the bone reconstruction therapy, while the control group was not. All the patients received the follow-up ranging 6 months to 1 year, and examined with CT and/or MRI to observe leakage of cerebrospinal fluid, intracranial infection and encephalomeningocele. Results In the treatment group, one of the 18 survivals developed mild cerebrospinal fluid leakage, which was cured later. In the control group, 5 of the 17 survivals had cerebrospinal fluid leakage, 3 had intracranial infection and 3 encephalomeningncele. The total incidence of complications of the treatment and control groups was 1/18 and 5/17, respectively, and the former was significantly lower than the latter （P〈0.05）. Conclusions Bone reconstruction can avoid intracranial infection, cerebrospinal fluid leakage and encephalomeningocele during the operation for traumatic comminuted fractures of anterior skull base.