Clemenza J W, Kaltman S I, Diamond D L
Department of Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
J Oral Maxillofac Surg. 1995 Sep;53(9):1004-7. doi: 10.1016/0278-2391(95)90114-0.
The study examines the efficacy of antibiotic treatment in patients with traumatic cerebrospinal fluid (CSF) leakage and identifies a consistent clinical approach for better management of these patients.
A retrospective study of traumatic CSF leakage in 88 patients with craniofacial fractures was performed. The mechanism of injury, etiology and source of leakage, decision to treat conservatively (without surgery) versus aggressively (with surgery), decision to use early versus late repair, and decision to provide prophylactic antibiotic coverage were recorded. Both timing of repair and the decision to use antibiotics were compared with the incidence of meningitis resulting from CSF leakage.
Of 48 patients treated with antibiotics, 5(10.4%) developed meningitis. In the remaining 40 who were not treated with antibiotics, only one patient acquired meningitis. Five of 53 (9.4%) patients with conservative treatment developed meningitis versus 1 of 35 (2.9%) after aggressive treatment.
There was no statistically significant difference in the rate of occurrence of meningitis between the conservative and the aggressive treatment group. However, the data suggest that there may be no benefit in treating these patients with antibiotics to prevent meningitis, whereas aggressive treatment and early repair of facial fractures may, in fact, be helpful.
本研究探讨抗生素治疗外伤性脑脊液漏患者的疗效，并确定一种一致的临床方法以更好地管理这些患者。
对88例颅面骨折合并外伤性脑脊液漏患者进行回顾性研究。记录损伤机制、漏液的病因和来源、保守治疗（不手术）与积极治疗（手术）的决策、早期修复与晚期修复的决策以及预防性使用抗生素的决策。将修复时机和使用抗生素的决策与脑脊液漏导致的脑膜炎发生率进行比较。
在48例接受抗生素治疗的患者中，5例（10.4%）发生脑膜炎。在其余40例未接受抗生素治疗的患者中，仅有1例发生脑膜炎。53例保守治疗患者中有5例（9.4%）发生脑膜炎，而积极治疗后35例中有1例（2.9%）发生脑膜炎。
保守治疗组和积极治疗组脑膜炎发生率无统计学显著差异。然而，数据表明用抗生素治疗这些患者预防脑膜炎可能没有益处，而积极治疗和早期修复面部骨折实际上可能是有益的。
