Lee D, Honrado C, Har-El G, Goldsmith A
Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, Pennsylvania 15213, USA.
Laryngoscope. 1998 Jun;108(6):816-21. doi: 10.1097/00005537-199806000-00008.
To examine the etiology, presentation, and management of temporal bone fractures in children.
Case control.
Retrospective review of a level I pediatric trauma center from July 1, 1990 to November 1, 1996 identified 680 patients. Inclusion criteria of age less than 14 years and only blunt temporal bone trauma identified 122 patients, with 97 charts available for review. The criteria for temporal bone fracture consisted of both clinical and radiologic information. Only patients with temporal bone fractures confirmed by computed tomography, a complete otolaryngology examination, and audiometric evaluations were included in the study. The data were analyzed with the Kruskal-Wallis analysis of variance (ANOVA) for examining the three separate age groups of fractures. Chi-squared analysis was used to compare these data with previously published adult and pediatric temporal bone fracture series and to examine the three separate age groups of fractures.
The review identified 72 children with 79 temporal bone fractures: 47 boys and 25 girls. The patients ranged from 6 months to 14 years of age, with a bimodal distribution of patients with peaks at 3 years and 12 years of age. The most common causes of fractures were motor vehicle accidents (47%), falls (40%), biking accidents (8%), and blows to the head (7%). Common presenting signs and symptoms included hearing loss (82%), hemotympanum (81%), loss of consciousness (63%), intracranial injuries (58%), bloody otorrhea (58%), extremity fractures (8%), and facial nerve weakness (3%). The most common causes of temporal bone fractures were falls and motor vehicle accidents. Forty-two patients were noted to have bloody otorrhea and possible cerebrospinal fluid leak. Twenty-four received intravenous antibiotics. No patient developed prolonged otorrhea or meningitis during hospitalization and the follow-up period. The classification of fracture patterns was longitudinal, 54%; transverse, 6%; oblique, 10%; squamous, 27%; and other, 3%. Hearing loss was found in 59 patients, with conductive hearing loss being the most common finding in 56% of the patients, followed by sensorineural hearing loss in 17% and mixed hearing loss in 10%.
Pediatric temporal bone fractures are associated with falls and motor vehicle accidents. There is a high incidence of associated intracranial injuries and hearing loss, but facial nerve injuries are uncommon. Timely management minimizes complications.
探讨儿童颞骨骨折的病因、临床表现及治疗方法。
病例对照研究。
回顾性分析1990年7月1日至1996年11月1日期间，某一级儿童创伤中心收治的680例患者。纳入标准为年龄小于14岁且仅有钝性颞骨外伤，共确定122例患者，其中97份病历可供查阅。颞骨骨折的诊断标准包括临床和影像学资料。只有经计算机断层扫描、全面的耳鼻喉科检查及听力评估确诊为颞骨骨折的患者才纳入本研究。采用Kruskal-Wallis方差分析（ANOVA）对三个不同年龄组的骨折数据进行分析。采用卡方分析将这些数据与先前发表的成人及儿童颞骨骨折系列进行比较，并对三个不同年龄组的骨折情况进行分析。
该回顾性研究共纳入72例儿童患者，发生79例颞骨骨折：47例男孩，25例女孩。患者年龄范围为6个月至14岁，呈双峰分布，高峰年龄分别为3岁和12岁。骨折最常见的原因是机动车事故（47%）、跌倒（40%）、自行车事故（8%）和头部撞击（7%）。常见的症状和体征包括听力丧失（82%）、鼓膜积血（81%）、意识丧失（63%）、颅内损伤（58%）、血性耳漏（58%）、四肢骨折（8%）和面神经麻痹（3%）。颞骨骨折最常见的原因是跌倒和机动车事故。42例患者出现血性耳漏，可能存在脑脊液漏。24例患者接受了静脉抗生素治疗。住院期间及随访期间，无患者出现持续性耳漏或脑膜炎。骨折类型分类为：纵行骨折占54%；横行骨折占6%；斜行骨折占10%；鳞状骨折占27%；其他类型占3%。59例患者存在听力丧失，其中56%的患者最常见的是传导性听力损失，其次是感音神经性听力损失占17%，混合性听力损失占10%。
儿童颞骨骨折与跌倒和机动车事故有关。颅内损伤和听力丧失的发生率较高，但面神经损伤并不常见。及时治疗可将并发症降至最低。
