小儿颅脑外伤合并股骨干骨折23例救治分析

Diagnosis and treatment of brain trauma with concomitant femoral shaft fracture in children of 23 cases

目的探讨小儿颅脑外伤合并股骨干骨折损伤机制、救治措施及预后。方法总结我科近4年来住院病例。探讨股骨受暴力后颅脑损伤的机制,股骨干骨折手术时机的选择以及预后。结果此类患儿系暴力撞击大腿后,头部着地造成减速伤,颅脑受伤机制中有剪切力存在。除2位轻型颅脑外伤患儿外,中重型颅脑外伤患儿入院CT大都表现白质及灰白质交界处、基底节及胼胝体处多发点灶样挫伤。患儿昏迷时间为5～178天,平均23.1±4.2天。患儿吞咽功能恢复后行弹性髓内钉固定术效果好,肺部并发症较轻。结论收住神经外科颅脑外伤合并股骨干骨折患儿颅脑受伤机制大都伴有剪切力存在。虽然颅脑损伤严重,但大部分患儿经过正确的治疗仍可获得较好的预后。

Objective To investigate the diagnosis and treatment of brain trauma with concomitant femoral shaft fracture in children.Methods We study the cases of brain trauma with concomitant femoral shaft fracture in children of the past 4 years,so as to evaluate the curative effect of early fixation of femoral shaft fracture and delayed fixation,to discuss the mechanism of this special kind of trauma and its prognosis.Results 21 cases of 23 children suffer from diffuse axonal injury with characteristic sign of brain CT.The comatose state lasts from 5 to 178 days.Better results come from the children who receive the application of titanium elastic nails for treating femoral shaft fractures after recovering their deglutition,which also suffering less Respiratory complications.Conclusion Shear stress plays an important role in children suffering from brain trauma with concomitant femoral shaft fracture.Most of the children can get good outcome by being treated correctly.