CAJ | 학술논문

目的：探讨合并脑脊液漏的前颅底骨折颅底重建的指征及时机。方法回顾性分析2006年～2012年117例前颅底骨折合并脑脊液漏患者的临床资料。分析术前螺旋CT扫描并根据影像数据将患者被分为3组。Ⅰ型组：单纯骨折无明显移位（垂直脑膜方向≤5 mm）；Ⅱ型组：骨折移位明显但不伴有气颅；Ⅲ型组：无论骨折是否移位伴气颅。所有患者均纳入定期随访机制。结果70例患者保守治疗后脑脊液漏停止，24例患者因颅内血肿或脑疝一期手术同时行颅底修复，20例患者因脑脊液漏或继发脑膜炎二期颅底重建。Ⅱ型和Ⅲ型患者进行二期颅底重建术与Ⅰ型相比较差异有统计学意义。结论合并脑脊液漏的前颅底骨折患者术前应仔细评估三维CT并作出最佳治疗选择，气颅及骨折移位均是颅底重建的重要指征，应结合病人临床情况及时修复。
목적：탐토합병뇌척액루적전로저골절로저중건적지정급시궤。방법회고성분석2006년～2012년117례전로저골절합병뇌척액루환자적림상자료。분석술전라선CT소묘병근거영상수거장환자피분위3조。Ⅰ형조：단순골절무명현이위（수직뇌막방향≤5 mm）；Ⅱ형조：골절이위명현단불반유기로；Ⅲ형조：무론골절시부이위반기로。소유환자균납입정기수방궤제。결과70례환자보수치료후뇌척액루정지，24례환자인로내혈종혹뇌산일기수술동시행로저수복，20례환자인뇌척액루혹계발뇌막염이기로저중건。Ⅱ형화Ⅲ형환자진행이기로저중건술여Ⅰ형상비교차이유통계학의의。결론합병뇌척액루적전로저골절환자술전응자세평고삼유CT병작출최가치료선택，기로급골절이위균시로저중건적중요지정，응결합병인림상정황급시수복。
Objective This study estimated the indication and opportunity of the reconstruction for fracture of anterior skull base with cerebrospinalfl uid (CSF) leakage.Methods The clinical data of 117 cases of fracture of anterior skull base combined with cerebrospinalfl uid leakage were analyzed retrospectively. Patients were divided into three groups by the results of 64-slices CT.Ⅰ- simple fracture has no obvious shift (vertical meningeal≤5 mm);Ⅱ- fracture displacement without pneumocephalus;Ⅲ- pneumocephalus and regardless of whatever fracture. All patients were included in the regular follow-up.Results70 patients without anterior skull base reconstruction, the repair of the skull base surgery were conducted in 24 at initial operation, 20 patients undergo the reconstruction of the skull base due to the leakage of cerebrospinalfl uid or secondary meningitis. Patients with typeⅡ and typeⅢ for second phase of the reconstruction of the skull base has signifi cant difference compared with typeⅠ.ConclusionThree-dimensional CT is an appropriate assessment tool for the fracture of the skull base. The presence of pneumocephalus and displacement fracture were the factors influencing the surgical indication. Reconstruction should be the choice according to the clinical situation of patients.