Oktay Kadir, Guzel Ebru, Unal Emre, Yilmaz Tevfik, Okten Ali Ihsan, Guzel Aslan
Department of Neurosurgery, Gaziantep Medical Park Hospital, Gaziantep, Turkey,
Department of Radiology, Gaziantep Medical Park Hospital, Gaziantep, Turkey.
Pediatr Neurosurg. 2019;54(1):28-35. doi: 10.1159/000495807. Epub 2019 Jan 23.
To evaluate pediatric patients who were operated with the diagnosis of depressed skull fracture.
The records of pediatric patients who presented with traumatic head injury to multicenter neurosurgery clinics between 2002 and 2018 and who were operated with a diagnosis of depressed skull fracture were retrospectively reviewed. All of the patients underwent primary bone fragment replacement operation, and the patients' own bone flaps were used to repair depressed skull fractures in all of them.
A total of 78 patients were included in the study. Of the study group, 20 patients presented with mild head injury, 37 had moderate head injury, and 21 had severe head injury. Dural injury was present in 67 patients (86%) and the dura was intact in 11 patients (14%). After surgery, 63 patients (81%) had good outcome, 8 patients (10%) had moderate disability, and 5 patients (6.5%) had severe disability. Two patients with multiple accompanying cranial pathologies died and the mortality rate was 2.5%. Infection was detected in only 2 of the 78 patients who were treated within the first 72 h after trauma. One of them had meningitis and the other skin infection. Both patients were treated with appropriate antibiotherapy. None of the patients in the study group had an infection involving the bone, such as osteomyelitis, or the tissues under the bone, such as subdural-epidu-ral empyema or abscess. None of the patients required reoperation and removal of the bone.
In the present study, as the pathologies accompanying the depressed skull fractures of the patients increased, Glasgow Coma Scale scores at arrival and Glasgow Outcome Scale scores at discharge decreased. Regardless of whether the depressed fracture is simple or compound, primary bone fragment replacement with appropriate decontamination of the fractured bone and operation area via single-session intervention gives good results. It is important to perform the surgery as soon as possible to reduce the risk of contamination. Primary bone fragment replacement seems to be an appropriate treatment option for depressed skull fractures.
评估诊断为颅骨凹陷性骨折并接受手术治疗的儿科患者。
回顾性分析2002年至2018年间多家中心神经外科诊所收治的因创伤性颅脑损伤就诊且诊断为颅骨凹陷性骨折并接受手术治疗的儿科患者的病历。所有患者均接受了原发性骨碎片复位手术，且全部使用患者自身的骨瓣修复颅骨凹陷性骨折。
本研究共纳入78例患者。研究组中，20例为轻度颅脑损伤，37例为中度颅脑损伤，21例为重度颅脑损伤。67例患者（86%）存在硬脑膜损伤，11例患者（14%）硬脑膜完整。术后，63例患者（81%）预后良好，8例患者（10%）有中度残疾，5例患者（6.5%）有重度残疾。2例伴有多种颅脑病变的患者死亡，死亡率为2.5%。在创伤后最初72小时内接受治疗的78例患者中，仅2例检测到感染。其中1例患有脑膜炎，另1例患有皮肤感染。两名患者均接受了适当的抗生素治疗。研究组中没有患者发生涉及骨骼的感染，如骨髓炎，或骨骼下方组织的感染，如硬脑膜下-硬脑膜外积脓或脓肿。没有患者需要再次手术取出骨头。
在本研究中，随着患者颅骨凹陷性骨折伴随病变的增加，入院时的格拉斯哥昏迷量表评分和出院时的格拉斯哥预后量表评分降低。无论凹陷性骨折是单纯性还是复合型，通过单次干预对骨折骨和手术区域进行适当的去污后进行原发性骨碎片复位，效果良好。尽早进行手术以降低污染风险很重要。原发性骨碎片复位似乎是治疗颅骨凹陷性骨折的合适选择。
