CAJ | 학술논문

背景：对于小儿颅骨粉碎凹陷性骨折的手术治疗，如能做到既保留自身颅骨及缩小手术切口，又能保证手术安全及治疗效果，不但符合微创手术的理念，更是患儿家长们的经常要求。目的：探讨小切口游离部分骨片原位回植治疗小儿颅骨凹陷粉碎性骨折的效果。方法：试验选择3-16岁闭合性颅骨凹陷粉碎性骨折患者15例，全身麻醉后根据CT检查及触摸骨折处头皮等方法标记出骨折范围，再选定适当部位及大小的一二个骨片，采用游离部分骨片原位回植加撬拔术治疗，术中采用长度与可取下切口下一二个碎骨片外侧缘等长的小切口。术后随访观察临床效果。结果与结论：切口长度5-7cm，取出1个骨片6例，取出2个骨片9例；术中清除硬膜外血肿6例，硬膜下血肿3例，扩大硬膜切口处理脑挫裂伤及出血6例；使用1个颅骨锁固定8例，2个颅骨锁6例；使用3个连骨板固定1例。术后CT显示12例骨折复位良好，与对侧颅骨基本对称；3例部分骨片仍略有凹陷，但均小于0.5 cm；6例遗留少许颅骨缺损，直径<1.0 cm；6例伴少量硬膜外血肿或积液，保守治疗后吸收。11例患者随访2个月-3年，CT检查骨折区颅骨形状与出院时无变化，稳定性良好；1例遗留肢体轻度偏瘫，1例遗留轻度语言障碍，1例出现轻度癫痫发作，药物控制良好。提示游离部分骨片原位回植治疗小儿颅骨粉碎凹陷性骨折疗效满意。
배경：대우소인로골분쇄요함성골절적수술치료，여능주도기보류자신로골급축소수술절구，우능보증수술안전급치료효과，불단부합미창수술적이념，경시환인가장문적경상요구。목적：탐토소절구유리부분골편원위회식치료소인로골요함분쇄성골절적효과。방법：시험선택3-16세폐합성로골요함분쇄성골절환자15례，전신마취후근거CT검사급촉모골절처두피등방법표기출골절범위，재선정괄당부위급대소적일이개골편，채용유리부분골편원위회식가효발술치료，술중채용장도여가취하절구하일이개쇄골편외측연등장적소절구。술후수방관찰림상효과。결과여결론：절구장도5-7cm，취출1개골편6례，취출2개골편9례；술중청제경막외혈종6례，경막하혈종3례，확대경막절구처리뇌좌렬상급출혈6례；사용1개로골쇄고정8례，2개로골쇄6례；사용3개련골판고정1례。술후CT현시12례골절복위량호，여대측로골기본대칭；3례부분골편잉략유요함，단균소우0.5 cm；6례유류소허로골결손，직경<1.0 cm；6례반소량경막외혈종혹적액，보수치료후흡수。11례환자수방2개월-3년，CT검사골절구로골형상여출원시무변화，은정성량호；1례유류지체경도편탄，1례유류경도어언장애，1례출현경도전간발작，약물공제량호。제시유리부분골편원위회식치료소인로골분쇄요함성골절료효만의。
BACKGROUND:For depressed skul fractures in children, retaining their skul and narrowing surgical incision meet the concept of minimaly invasive surgery as important as ensuring the surgical safety and therapeutic effects, which is also the requirement of children’s parents. OBJECTIVE:To explore the curative effects of in suit replantation of free bone fragments based on a smal incision in children with depressed skul fractures. METHODS: Fifteen patients with depressed skul fractures, aged 3-16 years, were selected and subject to CT examination and manual examination of the scalp at fractured site under general anesthesia for labeling fracture range. Then, one or two bone fragments corresponding to the fracture site and size were selected. A smal incision with a length equal to the outer edge of bone fragments removed. Postoperative folow-up was employed for observation of clinical effects. RESULTS AND CONCLUSION:An incision, 5-7 cm in length, were made, and one bone fragment was removed from six cases, and two bone fractures were removed from nine cases. Intraoperatively, there were six cases of epidural hematoma, three cases of subdural hematoma, six cases of brain contusion and bleeding. For fracture fixation, one skul lock was used in eight cases, two skul locks in six cases, and three bone plates in one cases. Postoperative CT showed 12 cases of good fracture reduction displayed basic symmetry with the contralateral skul; 3 cases showed partialy depressed bone fragments that were less than 0.5 cm; 6 cases had a little skul defects with a diameter < 1.0 cm; 6 cases had mild epidural hematoma or effusion which was eliminated after conservative treatment. Eleven of 15 cases were folowed for 2 month to 3 years, and showed no changes in skul shape on CT films compared with those at discharge and presented with good stability. In addition, there were one case of mild limb paralysis, one case of mild language barriers, and one case of mild seizures, but al these cased were wel controled by drugs. These findings indicate that in situ replantation of partialy free bone fragments is suitable for depressed skul fractures in children.