开放性颅脑损伤合并异物嵌插的诊断与治疗

Diagnosis and treatment of open traumatic brain injury embedded foreign objects

目的探讨开放性颅脑损伤合并异物嵌插的诊治方法。方法回顾性分析4例开放性颅脑损伤合并异物嵌患者的临床资料,总结诊治经验。治疗以变开放性损伤为闭合性损伤为原则,术后加强抗感染,预防癫痫发作。假性动脉瘤形成的高危患者早期进行处理。结果 1例异物刺入颅内假性动脉瘤形成患者,经异物拔除术及动脉瘤栓塞术后生命体征稳定,但意识模糊。右颅眶树枝嵌插伤患者经手术治疗神志清楚,左侧视力、瞳孔光反射正常,右侧视力眼前2米指数。重度开放性脑损伤患者术前昏迷,术后神志清楚,左侧视力正常。1例石弩弓箭贯通伤患儿予以保守治疗,出院时患儿肌肉萎缩、肌力Ⅳ级,神志清楚,恢复可。结论因外伤所致开放性颅脑损伤合并异物嵌插的类型各异。对头皮损伤者必须追问相关病史、完善影像学检查,必要时外科探查避免漏诊。异物残留患者必须清除异物及挫伤脑组织,闭合开放性损伤。对合并颌面部多发损伤患者可多科室合作,注意抗感染及预防癫痫发作。只有诊断明确、治疗恰当,才能提高疗效、缩短疗程、预防意外情况的发生。

Objective To explore the diagnosis and treatment of open craniocerebral injury embedded foreign objects .Methods The clinical data of 4 patients with open craniocerebral injury embedded foreign objects were analyzed retrospectively .The treatment principle was performed to change the open injury to close craniocerebral injury .Anti-infection, prevention of epilepsy, pseudoaneurysm after proper surgical therapy in time could be helpful for the patients successfully cured . Results Case 1 got injuried with transcranial embodded foreign objects and pseudoaneurysm .The patient underwent surgical and embolization was awareness of fuzzy .Case 2 suffered from the embedded tree-branch in the right eye socket .After interventions the patient could see clearly within 2 meters by the right eye with sanity .Case 3 was severe traumatic brain injury with insensible awareness .The patient got recovered of left insight after operation .Case 4 was a child injured by arrow of catapult .Conclusions Patients by traumatic brian injury with embedded foreign objects could be serious and the conditions may be varies .In order to prevent misdiagnosis , CT or CTA scan , injury history , and surgery explore may be helpful .After procedure , prevention of the intracranial infection and epilepsy is recommended .The patients may be cured if they could obtain an early diagnosis and correct treatment .