Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
Department of Neurosurgery, Gandak Hospital, Birgunj, Nepal.
J Neurol Surg A Cent Eur Neurosurg. 2024 Mar;85(2):147-154. doi: 10.1055/a-1994-9330. Epub 2022 Dec 8.
Depressed skull fractures have been well described since antiquity, yet its management remains controversial. Contentious issues include the use of prophylactic antibiotics and antiepileptics, the role of nonoperative management, and the replacement/removal of bone fragments. Our objective was to explore the management patterns of closed and open depressed skull fractures across the world.
A 23-item, web-based survey was distributed electronically to the members of national neurosurgical associations, and on social media platforms. The survey was open for data collection from December 2020 to April 2021.
A total of 218 respondents completed the survey, representing 56 countries.With regard to open fractures, most respondents (85.8%) treated less than 50 cases annually. Most respondents (79.4%) offered prophylactic antibiotics to all patients with open fractures, with significant geographical variation ( < 0.001). Less than half of the respondents (48.2%) offered prophylactic antiepileptics. Almost all respondents (>90%) reported the following indications as important for surgical management: (1) grossly contaminated wound, (2) dural penetration, (3) depth of depression, and (4) underlying contusion/hematoma with mass effect. Most respondents treated less than 50 cases of closed depressed skull fractures annually. Most European respondents (81.7%) did not offer prophylactic antiepileptics in comparison to most Asian respondents (52.7%; < 0.001). Depth of depression, an underlying hematoma/contusion with mass effect, and dural penetration were the most important surgical indications.
There remains a great degree of uncertainty in the management strategies employed across the world in treating depressed fractures, and future work should involve multinational randomized trials.
自古代以来，人们对凹陷性颅骨骨折已有详细的描述，但在其治疗方面仍存在争议。存在争议的问题包括预防性使用抗生素和抗癫痫药、非手术治疗的作用以及骨碎片的置换/去除。我们的目的是探讨全球范围内闭合性和开放性凹陷性颅骨骨折的治疗模式。
我们以 23 个项目为基础，通过电子方式向各国神经外科学会成员以及社交媒体平台分发了网络调查问卷。该调查于 2020 年 12 月至 2021 年 4 月期间开放收集数据。
共有 218 名受访者完成了调查，代表了 56 个国家。对于开放性骨折，大多数受访者（85.8%）每年治疗的病例少于 50 例。大多数受访者（79.4%）向所有开放性骨折患者提供预防性抗生素，且存在显著的地域差异（ < 0.001）。不到一半的受访者（48.2%）提供预防性抗癫痫药。几乎所有受访者（>90%）报告了以下手术治疗的重要指征：（1）严重污染的伤口，（2）硬脑膜穿透，（3）凹陷深度，和（4）有肿块效应的基础挫裂伤/血肿。大多数受访者每年治疗的闭合性凹陷性颅骨骨折少于 50 例。与大多数亚洲受访者（52.7%； < 0.001）相比，大多数欧洲受访者（81.7%）不提供预防性抗癫痫药。凹陷深度、有肿块效应的基础血肿/挫裂伤以及硬脑膜穿透是最重要的手术指征。
在全球范围内，治疗凹陷性骨折所采用的治疗策略仍然存在很大程度的不确定性，未来的工作应包括跨国随机试验。
