前颅底骨折伴脑脊液鼻漏的颅底修复与重建治疗

Reconstruction and repairing of anterior skull base fracture with cerebrospinal fluid rhinorrhea

目的分析颅底骨性重建和膜性重建治疗前颅底骨折伴脑脊液鼻漏患者的安全性及临床疗效。方法收集西南医科大学附属中医医院神经外科自2013年6月至2017年10月收治的前颅底骨折伴脑脊液鼻漏患者40例,均行前颅底修复与重建手术治疗,对其临床诊断、手术治疗及临床预后进行分析。结果初次手术后36例患者脑脊液鼻漏停止,4例患者术后仍然有脑脊液鼻漏,后再次接受开颅手术修复重建治疗,术后脑脊液鼻漏全部停止。3例患者发生脑膜炎,静脉使用抗生素后2例治愈,1例死亡。术后随访3～36个月,预后良好者33例(82.5%),预后不良者6例(15.0%),死亡1例(2.5%)。结论开颅颅底骨性重建和膜性重建修复是前颅底骨折伴随的脑脊液鼻漏的有效治疗方法,手术并发症发生率低,患者恢复效果好。

Objective To analysis the safety and efficacy of bone and membrane reconstruction of anterior skull base fracture with cerebrospinal fluid rhinorrhea. Methods Forty patients who suffered from fractures of anterior skull base with cerebrospinal fluid rhinorrhea and accepted the bone and membrane reconstruction of anterior skull base in our hospital from June 2013 and October 2017 were treated with anterior skull base repair and reconstruction. Their clinical diagnosis, surgical treatment and clinical outcome were analyzed. Results After the initial operation, 36 cases of patients with cerebrospinal fluid rhinorrhea stoped and 4 patients still had cerebrospinal rhinorrhea, and all cerebrospinal fluid rhinorrhea stoped after the second time surgical repair and reconstruction. A total of 3 patients suffered from meningitis, 2 patients were cured after intravenous infusion of antibiotics, and 1 patients died. After 3 to 36 months of follow-up, 33 cases (82.5%) had good prognosis, 6 cases (15.0%) had poor prognosis and 1 case (2.5%) died. Conclusion The reconstruction and repairing of anterior skull base is the effective treatment method of anterior skull base fracture with cerebrospinal fluid rhinorrhea. The incidence of surgical complications was low, and patients have good recovery effect.