面中部骨折伴外伤性脑脊液鼻漏同期治疗163例临床分析

目的:回顾分析面中部骨折伴外伤性脑脊液鼻漏的诊断以及同期治疗的手术方法。方法:选择2003年1月—2010年5月本院收治的脑外伤病例中脑挫裂伤、颅内血肿、原发性脑干损伤等脑外伤病情趋于稳定后仍存在脑脊液鼻漏的患者163例,对其发病年龄、致伤原因、住院天数、骨折特点、诊断及手术方法等进行分析。结果:163例行同期手术的患者中,术后1周脑脊液鼻漏消失者占全部病例的88.96%,2～3周后脑脊液鼻漏消失者占10.43%,仅有1例术后2周因颅内感染死亡;4例面神经颞支损伤,2例出现头皮麻木和感觉异常者,术后半年至1年症状消失;13例出现颞窝凹陷;所有患者术后咬合关系及开口度均恢复正常,面部外形基本对称。结论:同期处理面中部骨折与脑脊液鼻漏符合保守治疗超过1周即可行脑脊液鼻漏修补的原则,且可利用同一软组织切口进行手术,避免了分次手术的二次创伤,缩短了住院时间,节省了患者的治疗成本,减少了并发症的发生。同期治疗可使两者相得益彰,部分面中部骨折的复位固定可在一定意义上促进脑脊液鼻漏的恢复。

Treatment of 163 midfacial fractures with traumatic cerebrospinal rhinorrhea

PURPOSE:Retrospective analysis of the diagnosis and simultaneous treatment of midfacial fractures with traumatic cerebrospinal rhinorrhea.METHODS: One hundred and sixty three cases with contusion and laceration of brain,intracranial hematoma,primary brain-stem injury presented cerebrospinal rhinorrhea after reposition and fixation of the fractures from January 2003 to May 2011.They were analyzed in the respect of age,rate of blindness,length of stay in hospital,clinical characteristics,diagnosis and operation methods.RESULTS: 88.96% of the cerebrospinal rhinorrhea cured after 1 week,10.43% cured after 2-3 weeks,and 1 patient died because of intracranial infection after 2 weeks,4 cases with injury of temporal branch of facial nerve,2 cases of numbness of scalp and paraesthesia with no syndrome after half a year,13 cases had temporal fossa.The occlusion and mouth opening of all patients recovered and their faces were symmetrical depression.CONCLUSIONS: Treatment of facial trauma and cerebrospinal rhinorrhea simultaneously were consistent with the principle that cerebrospinal rhinorrhea reparation should do after 1 week of conservative therapy.The same incision can be used during operation,thus shortening the length of stay,reducing cost and complications,and promoting the resolution of cerebrospinal rhinorrhea.