24例婴幼儿颅骨生长性骨折的早期诊治

The early diagnosis and treatment for growing skull fracture in infant （24 cases report）

目的 探讨儿童颅骨生长性骨折的临床特点和早期诊断及治疗的意义.方法 回顾性分析本院2007年1月至2013年4月收治的24例经手术确诊为婴幼儿颅骨生长性骨折的患儿临床资料.结果 24例患儿均有颅脑外伤史,CT或MRI检查显示脑挫裂伤及脑软化,头颅3D-CT检查显示颅骨骨折.24例患儿均在就诊后16 d内明确诊断并手术治疗,术中均发现硬脑膜破裂,其中22例行硬脑膜修补和颅骨复位固定手术;1例行硬脑膜修补及颅骨修补手术,1例仅行颅骨修补手术;2例合并脑积水,先行V-P手术.随访1个月至6年,颅骨生长良好,无手术并发症.结论 颅骨骨折和硬脑膜破裂是发生生长性骨折的重要因素;头颅3D-CT及MRI检查对婴幼儿生长性骨折的早期诊断有重要价值,一旦确诊应尽早手术治疗;早期硬脑膜修补和颅骨成形治疗可防止产生进一步的脑损害和更大的颅骨缺损.

Objetive To summarize the clinical feature and the experience of diagnosis and treatment for growing skull fracture in infant. Methods 24 cases with growing skull fracture that underwent the surgical treatment in our department from Jan. 2007 to Apr. 2013 were retrospectively analyses. Results All 24 cases had history of head trauma. CT or MRI examination showed brain contusion and encephalomalacia. Skull 3D - CT examination showed a skull fracture. All cases were diagnosed and treated within 16 days after first visit. Intraoperative dural rupture was found in all cases, 22 of which were ean＇ied out the dura repair and skull fixa- tion surgery ; one case was underwent dural repair and cranioplasty, another one case only apply the eranioplas- ty surgery. 24 patients were followed up for 1 months to 6 years, found no complications. Condusions Skull fracture and dural rupture is the most important factors of the growing skull fractures. Skull 3D - CT and MRI has significant value on infant growing skall fracture. The surgical treatment should be performance as soon as diag- nosed. The dura repair and eranioplasty treatment can prevent further brain damage and larger skull defects.