Ito H, Miwa T, Onodra Y
Childs Brain. 1977;3(2):116-26.
It is recognized that the presence of a dural tear is essential in the development of a growing skull fracture. We present nine cases of growing skull fracture, stressing the importance of parenchymal injury beneath the skull and dural defects as pathogenic factors, and two cases which showed pathological conditions similar to those of growing skull fracture. According to our clinicla analysis, all of these cases followed head trauma in the first year of life. The area of cranial defect varied in size among the individual cases but was progressive in all instances. Convulsions were the most frequent symptom. With both radiologicla examinations and operative findings, it is recognized that dural tears and local cerebral injury are usually severe, and various localized ventricular enlargements are always found beneath the fracture. In many cases fibrous granulation was found filling in the bone defect and adhering to the contused cortex. The mechanism of the enlarged bone defect can be explained by classifying the lesions into three groups according to the type of tissue present: (1) granulation type; (2) cyst type, and (3) mixed type. Each type prevents the bone edge from spreading out, offering a suitable means to transmit mechanical pulsations of brain and cerebrospinla fluid. The formation of granulation tissue and dense scarring is an important factor in the growing skull fracture.
人们认识到，硬脑膜撕裂的存在对于生长性颅骨骨折的发展至关重要。我们报告了9例生长性颅骨骨折病例，强调颅骨下方实质损伤和硬脑膜缺损作为致病因素的重要性，以及2例表现出与生长性颅骨骨折相似病理状况的病例。根据我们的临床分析，所有这些病例均在生命的第一年发生头部外伤。颅骨缺损区域在个体病例中大小各异，但在所有情况下均呈进行性发展。惊厥是最常见的症状。通过影像学检查和手术发现，人们认识到硬脑膜撕裂和局部脑损伤通常很严重，并且在骨折下方总是发现各种局限性脑室扩大。在许多病例中，发现纤维肉芽组织填充骨缺损并附着于挫伤的皮质。根据存在的组织类型将病变分为三组，可以解释骨缺损扩大的机制：（1）肉芽型；（2）囊肿型，以及（3）混合型。每种类型都可防止骨边缘向外扩展，提供了一种传递脑和脑脊液机械搏动的合适方式。肉芽组织的形成和致密瘢痕形成是生长性颅骨骨折的一个重要因素。
