儿童颅骨生长性骨折

目的 探讨儿童颅骨生长性骨折(Growing skull fractwre，GSF)的发病机制、诊治方法。方法 对我院1992年1月2002年4月10年间收治的6例GSF患儿的临床资料进行回顾行分析。结果 6例均有明确颅脑损伤病史，平均发病年龄2．99岁，头部包块、颅骨缺损及神经功能障碍等症状常见，颅骨平片见以骨折线为长轴的梭形颅骨缺损，CT检查显示包块为蛛网膜囊肿或脑膨出，术中见硬脑膜缺损大于颅骨缺损；Goldstein分型：Ⅰ型2例，Ⅱ型2例，Ⅲ型2例；GOS5分者3例(2例Ⅰ型和1例Ⅱ型)，4分者2例(Ⅱ型和Ⅲ型各1例)，3分者1例(Ⅲ型)。结论 ①颅骨骨折致硬脑膜破损为GSF发病的病理基础，婴幼儿期颅脑发育、外伤后局部颅内压力增高、骨折缘缺血为发病的重要因素；②GSF患儿颅骨缺损范围与病程不呈正相关，颅脑CT在GSF的诊断方面优于颅骨平片；③GSF一经确诊即应手术治疗，扩大开颅术能显露硬脑膜残缘，严密修补硬脑膜是手术成功的关键，Medepor材料适用于GSF患儿。Goldstein分型对指导预后有一定意义。

Childhood growing skull fracture

Objective To study the mechanism, diagnosis and treatment of childhood growing skull fracture (GSF).Methods The clinical aspects of 6 patients with GSF on the admission from January 1992 to Aprial 2002 were analyzed retrospectively.Results The mean age of these patients was 2.99 years. The history of head trauma was found in all patients. Scalp mass, skull defect and neurological deficit were the common manifestations. Plain radiographs demonstrated the skull defects like an irregular oval shape with the long axis along the fracture line. The contents of the scalp mass which was mainly in the form of arachnoid cyst or brain herniation were shown clearly by CT scan. The loss of dura mater was greater than that of the skull could be noted during operation. Each 2 patients could be found in I, II and III type of Goldstein's system. There were 3 patients scored 5, 2 scored 4, and 1 scored 3 according to Glasgow Coma Scale scores.Conclusions 1. The basic pathological problem of GSF is dural laceration caused by skull fracture during infancy. It may be associated with some factors such as local intracranial hypertension, craniocerebral active growth and ischemia of the margin of the skull fracture. 2. There is not a relationship between the extent of skull defect and the course. CT scan is superior to plain radiograph in the early diagnosis of GSF. 3. Patients with GSF should be treated surgically as soon as the diagnosis was made. The key procedure is to perform a watertight duraplasty. In order to get a clear exposure of the edge of the dural defect, a wide craniotomy is essential. Medepor material is a suitable cranioplasty material for GSF patients. Goldstein Standard shows a significant correlation with the prognosis of such patients.