Kolodziejczyk D, Hirsch W D
Neurochirurgische Klinik im Zentralklinikum Augsburg.
Aktuelle Traumatol. 1992 Dec;22(6):272-5.
In various series reported in the literature on the operative management of severe head injuries with compound depressed skull fractures and penetrating wounds of the brain, the rates of infection differ from 1 to 17%. In this paper the operative experience with 22 cases of penetrating head injuries is discussed. In conventional operative therapy, depressed skull fracture and lacerated dura were covered by "Sulmycin Implant" containing Gentamycin as a helpful bacteriological barrier. 18 patients survived, 7 patients had severe neurological defects, 5 patients had mild neurological deficits and 6 patients recovered completely. There were no signs of suppurative complications in superficial wounds or in the brain. 4 patients died due to their severe brain damage with multiple contusional lesions. Postoperative complications were as follows: one patient suffered extradural and one patient subdural rebleeding. Another patient with a frontal base skull fracture suffered a pneumatocele because the fracture was not correctly covered. The revision was done successfully using the "Sulmycin Implant". Presently, however, the intradural use of "Sulmycin Implant" is not recommended without further testing for the level of gentamycin in the cerebrospinal fluid which is released by the "Sulmycin Implant".
在文献中报道的关于伴有复合性凹陷颅骨骨折和脑穿透伤的严重头部损伤手术治疗的各类病例系列中，感染率从1%到17%不等。本文讨论了22例穿透性头部损伤的手术经验。在传统手术治疗中，凹陷颅骨骨折和撕裂的硬脑膜用含有庆大霉素的“舒霉素植入物”覆盖，作为有益的细菌屏障。18例患者存活，7例有严重神经功能缺损，5例有轻度神经功能缺损，6例完全康复。浅表伤口或脑部均无化脓性并发症迹象。4例患者因严重脑损伤伴多发挫伤性病变死亡。术后并发症如下：1例患者发生硬膜外再出血，1例患者发生硬膜下再出血。另1例额骨基底部颅骨骨折患者因骨折未得到正确覆盖而出现气囊肿。使用“舒霉素植入物”成功进行了翻修手术。然而，目前在未进一步检测“舒霉素植入物”释放到脑脊液中的庆大霉素水平的情况下，不建议在硬膜内使用“舒霉素植入物”。
