带蒂帽状腱膜下层骨膜瓣修复前颅底缺损的临床研究

The clinical study of anterior skull base defects repaired with pedicled subgaleal and pericranial flap

目的 探讨带蒂帽状腱膜下层骨膜瓣在前颅底缺损修复中的治疗作用.方法 额发际内冠状切开头皮和帽状腱膜,紧贴帽状腱膜深面锐性分离,按缺损分型和范围设计瓣膜大小,将帽状腱膜下疏松结缔组织层和颅骨外膜合为一层从颅骨表面剥离,制成带蒂帽状腱膜下层骨膜瓣,用于修补15例外伤及26例肿瘤术后前颅底缺损患者.结果 本组患者缺损面积2.0 cm × 1.5 cm～6.5 cm ×4.0 cm,其中6例缺损＞4.0 cm×3.0 cm患者使用钛网板修复颅底骨缺损.所有外伤患者术后与颅底缺损有关的症状消失,两组均无颅内感染、搏动性突眼、额纹消失、上睑肌无力及额部头皮麻木和坏死等并发症发生,无围手术期死亡.术后两组各有1例发生脑脊液鼻漏,均经腰椎穿刺置管引流7 d内消失.结论 带蒂帽状腱膜下层骨膜瓣制备简单,对外伤或肿瘤术后2.0 cm×1.5 cm～4.0 cm×3.0 cm的前颅底缺损修补效果良好,是一种修补可靠、取材方便的前颅底缺损修补材料.

Objective To study the therapeutic effect of pedicled subgaleal and pericranial flap in the repair of the anterior skull base defects. Method A coronal operative incision in hairline scalp was made to cut scalp and galea aponeurotica, and a sharp dissection was carried out along with the deep surface of galea aponeurotica. The size of flap was designed based on the defect type and area, and subgaleal loose connective tissue together with pericranium as one layer was stripped from the skull surface to make a pedicled subgaleal and pericranial flap for 41 patients with anterior skull base defects, in which 15 caused by trauma and 26 by tumor surgery. Results The defect area of all cases ranged from 2.0 cm × 1.5 cm to 6.5 cm ×4.0 cm, in which 6 cases with areas more than 4.0 cm ×3.0 cm were repaired together with titanium mesh. After the operation, all symptoms related with anterior defect disappeared, and no complication occurred in both groups,such as intracranial infection, pulsating exophthalmos, disappeared forehead wrinkles, ptosis of the eyelid and numbness and necrosis of scalp on the forehead. No death happened in perioperative period. There was one case of transient cerebrospinal fluid leakage in both group and disappeared within 7 days after tube lumbar puncture draining. Conclusions Pedicled subgaleal and pericranial flap is easily made and has good effect in the repair of anterior skull base defects with an area from 2.0 cm × 1.5 cm to 4.0 cm ×3.0 cmresulted from trauma or tumor surgery. It is a reliable and easily obtained material for the repair of anterior skull base defects.