创伤性颅前窝底筛板区缺损

Cribriform plate defects at the anterior fossa basilar in head injury

目的 探讨外伤性颅前窝底筛板区缺损的临床特点 ,并对治疗方法进行分析。方法 回顾性分析1993年 1月～ 1999年 12月的 37例外伤性颅前窝底筛板区缺损的临床资料 ,治疗方法及随访结果。结果 随访 6个月～ 3年 ,37例均存活 ,格拉斯哥预后分级 (GOS)Ⅳ级 5例 ,Ⅴ级 32例。均无脑脊液漏。单独或合并有各种后遗症 30例。结论 清创术中及时发现筛板区缺损极为重要 ;缺损小于 1cm ,用骨蜡及医用胶修补即可 ;缺损大于1cm ,除用骨蜡外还需应用筋膜或肌瓣修补 ;硬脑膜严密缝合对预防脑脊液漏非常重要 ;术后颅内及伤口感染对修补的成功与否有直接影响 ,应严格、彻底地进行清创。由于手术是在头面部进行 。

Objective To discuss the clinical features of cribriform plate defects at the anterior fossa basilar in head injury and to analyze the treatment. Methods The cribriform plate defects in 37 patients with head injury from January, 1993 to December, 1999 were reviewed. The materials included clinical data, therapeutic alternatives, and follow-up results. Results Followed up for 6～36 months, the 37 patients were all alive, with Glasgow Outcome Scale (GOS) Ⅳ in 5 and Ⅴ in 32. All patients had no cerebrospinal fluid leakage. There were 30 cases with various sequelae. Conclusion It is very important to find the cribriform plate defects in time in the debridement. It can be repaired with bone wax when the defect is smaller than 1.0 cm , and besides bone wax, the fasciae or muscle petal should be used when the defect is as large as or larger than 1.0 cm . The wound surface must be cleaned radically to prevent intracranial or wound infection that can affect the success rate of repair. The operation must be performed according to the principle of cosmetology.