颅底骨折后颈动脉海绵窦瘘的发生及预后相关因素的分析

The occurrence of traumatic cavotid carernous fistula after fracture of basilaris cranii and its associated factors with outcome

目的分析不同类型颅底骨折后动脉海绵窦瘘的发生情况，以及影响预后的相关因素，探讨改善预后的方法。方法回顾性分析了浙江大学医学院附属第二医院1999年至2005年经血管造影证实的TCCF在不同类型颅底骨折中的发生率，并将患者分为“功能障碍组”和“非功能障碍组”，对TCCF预后相关的因素以及改善预后的方法进行了研究。结果312名颅底骨折患者中，有3．8％的患者发生TCCF，其中前、中、后颅底骨折的发生率分别是2．4％，8．3％和1．7％。在本次回顾性分析中，患者的年龄、性别、栓塞次数、发病时间，两组对比差异无统计学意义（P〉0．05）。但治疗时间两组间差异具有统计学意义（P〈0．05）。结论中颅底骨折，尤其是横位或者斜位的中颅窝骨折并发TCCF的可能相对较高，头面部外伤致中颅窝骨折后的患者需要及时检查以早期诊断TCCF或是避免漏诊，改善患者的预后。

Objective To analyze the occurrence of traumatic cavotid cavernous fistula （TCCF） resulted from the fracture of basilaris cranii, in order to find out the related factors to outcomes and to discuss the approaches to improving prognosis. Method Data of 312 patients with the fracture of skull base complicatcd with TCCF confirmed angiography from 1999 to 2005 were analyzed. These patients were classified into patients with disable and patients without disabed. The factors potentially impacting on outcomes were analyzed. Results The overall incidence of TCCF in 312 patients with fracture of basilaris cranii was 3.8 %. The ineideucs of TCCF occurred in patients with the fracture of anterior fossa, middle fossa and posterior fossa accounted for 2.4 %, 8.3 % and 1.7 %, respectively. Between two cohorts of patients, there were no difference in age, gender, number of embolization procedures performed and the time from injury to appearence of the first symptom except the differencc in time from appearence of the first symptom to the intravascular embolization pefformed （ P 〉 0.05）. Conclusions A relatively high incidence of TCCF occurs in patients with middle fossa fractures, especially those with transverse or oblique fractures. Prompt diagnosis and intervention can not be emphasized in case of patients with TCCF, and non invasive techniques for the early detection of TCCF under certain circumstance after brain or facial trauma should be considered so as to avoid a miss in the early diagnosis of middle fossa fracture to ensure favourable outcomes.