合并脑脊液漏的前颅底骨折的颅底重建

Study of Skull Base Reconstruction for Anterior Skull Base Fracture with Cerebrospinal Fluid Leakage

目的：探讨合并脑脊液漏的前颅底骨折颅底重建的指征及时机。方法回顾性分析2006年～2012年117例前颅底骨折合并脑脊液漏患者的临床资料。分析术前螺旋CT扫描并根据影像数据将患者被分为3组。Ⅰ型组：单纯骨折无明显移位（垂直脑膜方向≤5 mm）；Ⅱ型组：骨折移位明显但不伴有气颅；Ⅲ型组：无论骨折是否移位伴气颅。所有患者均纳入定期随访机制。结果70例患者保守治疗后脑脊液漏停止，24例患者因颅内血肿或脑疝一期手术同时行颅底修复，20例患者因脑脊液漏或继发脑膜炎二期颅底重建。Ⅱ型和Ⅲ型患者进行二期颅底重建术与Ⅰ型相比较差异有统计学意义。结论合并脑脊液漏的前颅底骨折患者术前应仔细评估三维CT并作出最佳治疗选择，气颅及骨折移位均是颅底重建的重要指征，应结合病人临床情况及时修复。

Objective This study estimated the indication and opportunity of the reconstruction for fracture of anterior skull base with cerebrospinalfl uid （CSF） leakage.Methods The clinical data of 117 cases of fracture of anterior skull base combined with cerebrospinalfl uid leakage were analyzed retrospectively. Patients were divided into three groups by the results of 64-slices CT.Ⅰ- simple fracture has no obvious shift （vertical meningeal≤5 mm）;Ⅱ- fracture displacement without pneumocephalus;Ⅲ- pneumocephalus and regardless of whatever fracture. All patients were included in the regular follow-up.Results70 patients without anterior skull base reconstruction, the repair of the skull base surgery were conducted in 24 at initial operation, 20 patients undergo the reconstruction of the skull base due to the leakage of cerebrospinalfl uid or secondary meningitis. Patients with typeⅡ and typeⅢ for second phase of the reconstruction of the skull base has signifi cant difference compared with typeⅠ.ConclusionThree-dimensional CT is an appropriate assessment tool for the fracture of the skull base. The presence of pneumocephalus and displacement fracture were the factors influencing the surgical indication. Reconstruction should be the choice according to the clinical situation of patients.