Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Neurosurgery. 2009 Dec;65(6):1063-9; discussion 1069. doi: 10.1227/01.NEU.0000360154.18604.28.
We report the morbidity and mortality associated with fractures of the clivus and discuss management approaches specific to this unique diagnostic entity.
We performed a boolean search of our electronic medical record database to identify patients with fractures of the clivus that were diagnosed using computed tomography of the head. A retrospective imaging and chart analysis was completed to further characterize the fractures and to analyze outcomes.
Between January 1999 and December 2007, 41 patients were identified with fractures of the clivus. We found a 0.21% overall incidence among all head-injured patients presenting to our institution and a 2.3% incidence among those patients with a cranial fracture. Ten of 41 patients (24.4%) died, and neurological and vascular complications associated with central cranial base fractures were observed in 19 of 41 patients (46%). Furthermore, associated cranial fractures remote from the central cranial base and associated intracranial hemorrhages were observed in 40 of 41 (97.6%) and 33 of 41 (80.5%) patients, respectively. In terms of outcomes, 26 of 41 patients (63.5%) had a Glasgow Coma Scale score of 12 or greater at the time of discharge from the hospital.
We demonstrate a lower than previously reported mortality rate in patients with clival fractures. Nevertheless, as a result of location, fractures of the clivus were frequently associated with a high rate of complications and neurological sequelae.
我们报告了与颅底斜坡骨折相关的发病率和死亡率，并讨论了针对这一独特诊断实体的特定治疗方法。
我们对电子病历数据库进行了布尔搜索，以确定使用头部计算机断层扫描诊断为颅底斜坡骨折的患者。进行了回顾性影像学和图表分析，以进一步描述骨折并分析结果。
1999 年 1 月至 2007 年 12 月期间，共确定了 41 例颅底斜坡骨折患者。我们发现，在我院就诊的所有头部受伤患者中，总体发病率为 0.21%，而在有颅部骨折的患者中，发病率为 2.3%。41 例患者中有 10 例（24.4%）死亡，19 例（46%）患者出现与颅底中央骨折相关的神经和血管并发症。此外，在 41 例患者中，40 例（97.6%）存在颅底中央以外的相关颅骨骨折，33 例（80.5%）存在颅内出血。就预后而言，41 例患者中有 26 例（63.5%）在出院时格拉斯哥昏迷量表评分达到 12 或更高。
与先前报道的结果相比，我们的研究中颅底斜坡骨折患者的死亡率较低。然而，由于位置的原因，颅底斜坡骨折常伴有高并发症和神经后遗症发生率。
