鼻内镜在累及额窦的额骨骨折手术中的应用

The application of nasal endoscopy in frontal bone fracture surgery involved the frontal sinus

目的探讨鼻内镜在累及额窦的额骨骨折手术中的应用。方法回顾性分析需要手术治疗的46例累及额窦的额骨凹陷骨折及粉碎性骨折患者的临床资料及随访结果,其中26例采取单纯开颅手术,另20例行开颅手术同时给予鼻内镜探查额隐窝并开放额隐窝或重建额窦开口并行额窦开放引流术。根据额窦症状及相关检查判断感染情况,利用卡方检验分析两种手术方式与预后的关系。结果术后随访1年,单纯开颅手术组26例患者额窦感染9例（34.61%）,5例额部皮肤破溃伴有窦道形成,再次入院后给予鼻内镜下行额窦开放引流术后痊愈。鼻内镜联合开颅手术组20例患者感染1例（0.05%）,两组比较,差异具有显著性（χ~2=4.22,P〈0.05）。改进术式后,在一期开颅手术的同时给予鼻内镜开放额窦隐窝及重建额窦开口通畅引流,可明显减少术后额窦的反复感染概率。结论有预见性地在开颅手术中借助鼻内镜开放额窦隐窝及重建额窦开口通畅引流,可以有效预防额骨凹陷骨折及粉碎性骨折术后引发的反复局部感染。

Objective To explore the application of nasal endoscopy in frontal bone fracture surgery involved the frontal sinus. Method A serial of 46 cases of frontal sinus fracture patient clinical data and follow-up results in craniofacial trauma center between January 2010 and January 2015 were reviewed. 26 cases take only surgical craniotomy,20 cases take surgical craniotomy while giving the nasal endoscopic probe fossae and open the frontal fossae or reconstruction of frontal sinus openings than give the frontal sinus open drainage. According sinus symptoms and related examinations to diagnose the sinus inspection. We use chi square test to find out the relationship between two kinds of surgical methods and prognosis. Result 26 cases of craniotomy operation of patients within 1 year follow-up of frontal sinus infection in 9 cases,infection rate is 34. 61%,20 cases with nasal endoscopic and surgical craniotomy operation of patients within 1 years follow-up of frontal sinus infection in 1 case,infection rate is 0. 05%. The infection rate is closely related to the surgical method（ χ2= 4. 22,P 〈0. 05）. With improved procedure,giving the nasal endoscopic probe fossae and reconstruct the opening of frontal sinus for drainage when processing the craniotomy,the risk of infection after repeated frontal sinus had significantly reduced. Conclusion Prescient in surgical craniotomy with open nasal endoscopic to open the frontal fossae and give the frontal sinus open drainage which can effectively prevent the frontal depressed fracture and shattered fracture caused by repeated local infection.