急性颅骨凹陷粉碎性骨折一期整复修补：64例报告

自2002年3月至2007年12月我们对64例急性凹陷粉碎性颅骨骨折患者，行一期手术整复修补，取得了良好效果，现报道如下。 一、对象与方法 1．一般资料：本组男43例，女21例，年龄3～65岁。闭合性颅骨凹陷性骨折39例，开放性25例。受伤情况：车祸伤36例，摔伤11例，坠落伤10例，打击伤7例。均在伤后24h内入院并手术。     

骨水泥在颅骨凹陷粉碎性骨折早期手术中的应用(附29例报告)

目的总结骨水泥在修复颅骨凹陷粉碎性骨折后争取恢复颅骨正常解剖结构中的经验。方法回顾性分析2009年6月～2011年10月我科应用骨水泥修复颅骨凹陷粉碎性骨折患者29例的临床资料。结果所有病例术后复查头部CT示基本恢复颅骨解剖结构,无术后感染病例。结论应用骨水泥修补凹陷粉碎性颅骨骨折,易操作,术后患者头部外观好,避免了二期手术,可明显减轻病人痛苦,节省患者医疗费用,具有较好临床实用价值。     

EC耳脑胶加丝线固定治疗颅骨粉碎性骨折

颅骨粉碎性骨折固定困难,以往多一期去除碎骨片,二期行颅骨修补。我院自1993年2月至1999年2月应用国产EC耳脑胶加丝线固定的方法治疗87例颅骨粉碎性骨折患者,取得了良好效果,现报告如下。1 临床资料1.1 一般资料 男62例,女25例,年龄5～54岁,平均26.8岁。病因:车祸伤39例,打击伤28例,坠     

应用丝线缝合法行颅骨粉碎性骨折一次性成形术的体会

临床颅骨粉碎性骨折常因骨折片无法成形还纳而造成颅骨缺损．我院自2001年2月至2005年6月采用丝线缝合法行颅骨碎骨片一次性成形术,还纳骨瓣20例,避免了颅骨缺损,获得了满意的效果。     

内窥镜辅助下微创手术整复婴幼儿颅骨凹陷性骨折

目的介绍一种治疗婴幼儿颅骨凹陷性骨折的微创手术。方法21例患儿,男15例,女6例,年龄4～24个月,平均10个月。骨折分别位于顶骨、额骨及枕骨,凹陷度>5mm。手术选取骨折边缘2cm长的小切口,颅骨钻孔,皮下游离后置内窥镜于骨折面,在内窥镜引导下用撬棒行颅骨复位。结果平均手术时间约20min,术后2～3d出院,复查CT颅骨复位良好,无颅内血肿、伤口感染、皮下积液、神经系统损伤、癫等并发症。结论婴幼儿颅骨凹陷性骨折在内窥镜辅助下,通过小切口也能成功复位。该方法创伤小,操作简便,视野清晰,手术及住院时间短,而且还有较好的美容效果。     

CRANIOFIX钛固定钉在颅骨凹陷性骨折整复中的应用

钛固定钉最初是用于开颅手术颅骨骨瓣的复位固定,极少用于颅骨凹陷性骨折的整复固定。我院自2004年5月-2005年12月采用钛固定钉修复治疗颅骨凹陷性骨折患者18例,手术后外形美观,内固定稳定,无不良反应,疗效良好。临床资料一、一般资料18例颅骨凹陷性骨折患者,男12例,女6例;年龄     

钛网支架在开放性颅骨粉碎性骨折固定术中的应用

<正>2005年1月至2009年2月对受伤后24h内开放性颅骨粉碎性骨折的45例患者行清创并对复位后不稳的骨片以钛网作支架一期固定修复,取得了良好效果。     

颅骨凹陷骨折复位器的临床应用

颅骨凹陷骨折在神经外科临床上较常见,骨折片的凹陷超过一定的限度须经手术复位。但是,达到理想的复位有时是比较困难。我们利用自行设计的一种架撑旋转提升式的颅骨复位器对17例颅骨凹陷骨折做手术复位,效果较好。     

儿童大面积开放性粉碎凹陷性颅骨骨折的治疗

儿童大面积开放性粉碎凹陷性颅骨骨折临床不多见，较易明确诊断，传统处理方法为去除碎骨片，遗留颅骨大面积缺损，择期进行二次颅骨修补。我院1999年8月-2000年2月对15例大面积开放性粉碎凹陷性颅骨骨折患儿的手术治疗方法进行改进，现总结如下。     

Spontaneous intrauterine depressed skull fractures

A survey is made of neonatal skull depressions as a result of experience with ten neonates harboring noniatrogenic intrauterine skull fractures. Several mechanisms causing intrauterine skull depression are discussed. Diagnosis was made after delivery in all cases and was confirmed by skull radiography. Various modes of therapy are mentioned and a stepwise guideline is suggested for correction of the depression by applying CT as an adjuvant diagnostic tool.     

镍钛形状记忆合金锔钉在颅骨凹陷骨折复位固定中的应用

目的 探讨闭合性颅骨凹陷骨折的手术治疗方法。。方法 对16例闭合性颅骨凹陷骨折患者应用镍钛形状记忆合金锔钉将复位之凹陷骨折片与正常颅骨固定。结果 随访5－54个月（平均26个月），无骨片移位与下陷、头皮下无积液、无排异反应或炎症，未见腐蚀，X线示复位固定之骨片与周围颅骨密度肉眼观察无明显异常。病人无精神负担，无不安全感。不影响CT、MR检查。结论 应用镍钛形状记忆合金锔钉固定复位之凹陷骨折骨片可获得良好的固定效果，有机械的回复力，手术操作简单，固定牢固，增强了骨折部位对外力的承受能力，整形效果好，合并症少，是目前较为理想的颅骨凹陷骨折治疗手段。     

静脉窦区颅骨凹陷性骨折的治疗策略

目的探讨静脉窦区颅骨凹陷性骨折的治疗策略。 方法回顾性分析福建医科大学福总临床医学院（第九〇〇医院）神经外科自2014年10月至2019年10月收治的静脉窦区凹陷性颅骨骨折患者的临床资料,观察保守治疗、骨折区手术及远隔部位手术的临床疗效。 结果研究共纳入35例患者,其中骨折区主要位于上矢状窦前1/3段14例,位于上矢状窦中1/3段9例,位于上矢状窦后1/3段11例,跨左侧横窦1例。保守治疗9例,均治愈出院。行手术治疗26例,其中8例行凹陷性骨折远隔区域硬膜下血肿清除+去骨瓣减压术,18例行骨折片整复及同部位硬膜外血肿清除术。26例手术患者中5例死亡,21例患者临床症状和神经功能均在较短时间内改善。 结论对于静脉窦区凹陷性颅骨骨折患者,应选择谨慎的手术方式及时机,有效控制手术出血,尽可能修补静脉窦壁的破损,并降低后期静脉循环障碍的发生率。     

Pediatric depressed skull fractures: analysis of 530 cases

Depressed skull fractures (DSFs) account for 7–10% of children admitted to hospital with a head injury and 15–25% of children with skull fractures. We reviewed the records of 530 patients operated on for DSF from January 1, 1973, to December 31, 1993. This group was made up of 357 boys (67%) and 173 girls (33%) whose ages ranged from 1 day to 16 years (mean age 6.1 years). Fall was the most common cause of injury. Of the 530 patients with DSF, 66% had compound fractures. the incidence of compound fractures increased with age. Compound fractures caused more brain lacerations (29%) than simple fractures (15.5%) did. We also classified DSFs radiologically as true, flat, or ping-pong ball fractures. Associated intracranial lesions were found to be a bad prognostic factor. There were 13 deaths (2.5%) in this series. Satis-factory results were achieved in over 95% of the patients. Compound fractures are associated with a worse outcome and a higher incidence of intracranial lesions and cortical laceration. Unilateral pupillary dilatation and an admission GCS score of 8 or less are ominous signs in regard to mortality. We also found that the deeper the depressed bone, the higher the risk of both dural tear and cortical laceration and the worse the prognosis. A conservative approach should be followed in cases of simple DSF without associated intracranial hematoma and in cases in which the bone depression is not deeper than 1 cm.Presented at the XXII Annual Meeting of the International Society for Pediatric Neurosurgery. Birmingham 1994     

Depressed skull fracture in Ping Pong: elevation with Medeva extractor

Introduction The bones of the skull of the newborn and nursing infants, in general, possess great malleability. For this reason, the depressed fractures occurring at this age are called “Ping Pong” or “Green Stick” fractures. The treatment of these fractures is surgical according to different authors, although some of these fractures that happen in childbirth can elevate themselves spontaneously. Technique A breast milk extractor trade mark “MEDEVA” was used for the procedure in newborns with a depression larger than 2 cm in diameter. Minimal aspiration was performed while observing the elevation through the transparent breast milk extractor MEDEVA until the depression elevated without leaving any trace. Discussion The aspiration procedure was satisfactory and curative in the five children treated. The fracture was successfully elevated and the skull returned to its normal position and configuration without complications for the patients. Conclusion Finally, it has been demonstrated that this procedure is simple, inexpensive, and avoids surgical intervention.     

Intracranial hypertension caused by superior sagittal sinus stenosis secondary to a depressed skull fracture: Case report and review of the literature

Depressed fractures that occur on the superior sagittal sinus (SSS) cause stenosis or thrombosis of the sinus in 11.5% of cases. Despite this, the appearance of signs and symptoms derived from high intracranial pressure is an infrequent event. So far, only 17 cases of venous sinus injury causing intracranial hypertension have been documented. It is necessary to establish treatment immediately before clinical suspicion. Surgical treatment by craniectomy is a fast, effective and safe alternative according to the series. However, it is necessary to anticipate the possibility of haemorrhage in the operating room.The case of a 7-year-old girl admitted for traumatic brain injury (TBI) with the diagnosis of a left parasagittal occipital sinus fracture that stenosed the posterior third of the superior sagittal sinus is presented. Upon arrival, she was asymptomatic, and conservative management was selected. Subsequently, the patient began to present with headache, nausea, vomiting and diplopia associated with bradycardia and apnoea pauses of central origin. She underwent surgery with a craniectomy with satisfactory clinical and radiological evolution and normalization of the intracranial pressure (ICP) registry.     

Posterior skull surgery in craniosynostosis

In 1984, two young infants with unusual clover-leaf patterns of skull deformity were treated by posterior skull-releasing surgery that dramatically improved their overall skull shape, to the extent that further operative intervention was not required. This focused our attention on the posterior skull and its role in craniosynostosis. In cases of multi-suture craniosynostosis and craniofacial syndromes severely raised intracranial pressure is frequent, demanding early surgery. One of the problems identified with such surgery undertaken before 6 months of age is recurrent craniosynostosis needing later re-operation. This occurred in 15 (5%) of 275 patients treated between 1978 and 1994. Since 1986, in the presence of significantly raised intracranial pressure it has been our policy to do an initial posterior skull release or decompression. This takes the pressure of the growing brain away from the orbits, allowing us to defer fronto-orbital advancement until the age of 12 months or later. Three patients managed in this way completely avoided anterior surgery, while in another 9 patients re-operation for recurrent anterior deformity has not been required. The exception to this policy has been the presence of severe exorbitism posing a threat to vision. Under these circumstances early fronto-orbital advancement is mandatory, and an additional posterior skull release may be helpful later. Debate continues especially on the management of unilateral lambdoid synostosis. The recent increase in positional posterior plagiocephaly, possibly related to supine nursing of newborns, has emphasised the need to differentiate between a fixed deformity, which might require surgical correction, and positional moulding of the occiput, which improves spontaneously. This paper reports our experience with 22 patients treated by posterior skull surgery, either alone or as an additional procedure, which we believe has a definitive role in the management of craniosynostosis.Presented at the Consensus Conference on Craniosynostoses, Rome, 4–6 May 1995     

经鼻内窥镜颅底手术

目的探讨经鼻内窥镜颅底手术的治疗效果。方法内窥镜下经鼻治疗垂体腺瘤２３例,颅咽管瘤２例,脑脊液鼻漏７例,蝶窦子弹异物３例,蝶窦囊肿５例,蝶窦霉菌病５例,蝶窦息肉１例,蝶筛窦腺癌１例,视神经管骨折１例,脑膜脑膨出１例。结果蝶窦囊肿、息肉和霉菌病痊愈;垂体微腺瘤和１例颅咽管瘤全切;侵袭性腺瘤、１例颅咽管瘤和蝶筛窦腺癌部分切除;视神经骨管骨折视力提向０．２;脑脊液鼻漏治愈,１例术后并发脑膜炎;蝶窦异物２     

多层螺旋CT颅骨三维图像重建在颅骨骨折中的应用研究

目的分析和对比多层螺旋CT（Multi-slice Spiral Computed Tomography,MSCT）与多层螺旋cT颅骨三维图像重建（Three dimensional reconstruction）在颅骨骨折中的影像表现,探讨多层螺旋CT颅骨三维图像重建在颅骨骨折中的临床应用价值。方法收集2009年12月～2012年10月我院收治的300例急性颅脑外伤（traumatic brain injury TBI）检查资料,均于伤后6h内行多层螺旋CT及颅骨三维图像重建检查,检出颅骨骨折病例82例,将数据运用统计学方法分析,比较两种检查方法的差异。结果多层螺旋CT颅骨三维图像重建在颅顶骨折（P=0．026）、颅底骨折（P=0．004）的检出率高于常规多层螺旋CT,具有统计学差异（P〈0．05）,并且有较高的特异性及敏感性。结论螺旋CT颅骨三维图像重建在颅骨骨折的诊断中优于MSCT,具有可靠的临床价值。     

Meningitis following basal skull fracture in two in-line skaters

Introduction In-line skating has been reported to cause severe head injury. Basilar skull fracture (BSF) is associated with a high risk of complication.Case report We report two children who had bacterial meningitis following seemingly trivial in-line skating injuries. In both, anterior BSF was diagnosed retrospectively following occurrence of Streptococcus pneumoniae meningitis.Discussion The clinical signs indicating BSF depend on the fracture location. Plain skull radiography and computed tomography (CT) are not sensitive enough to detect thin fractures in the anterior cranial fossa. We argue that high resolution multiple-plane CT and coronal T2-weighted magnetic resonance imaging are indicated to diagnose BSF.