论文部分内容阅读
目的探讨颅脑外伤后顽固性脑脊液耳漏手术治疗的技巧和策略。方法采用颞下中颅底-乳突后联合入路,对11例颅脑外伤后中颅窝底缺损所致脑脊液耳漏且保守治疗无效的患者施行手术修补。结果 1无需行乳突探查5例。因乳突为粉碎性骨折,在取下骨瓣前先行钛板固定2例。另外4例乳突粉碎骨折严重,术中将事先收集的颅骨碎屑回植到乳突缺损内,取头最长肌加生物胶加固;2术中发现有颅底广泛骨质缺损6例,脑组织疝入缺损中或乳突黏膜暴露广泛;3修补探查过程发现听骨链完整者3例,缺失2例,部分听小骨(锤骨)缺失2例,术中未探查听骨链者4例。术后随访2~11年,无复发。结论 1当合并复杂性骨折时,通过幕上幕下联合,经颞下中颅底-乳突后联合入路,无疑是明智的选择,尤其是不稳定骨折累及乳突的患者;2对颅底骨折复杂而听力完全丧失的脑脊液耳漏患者,除了封闭外耳道外,尚需进行鼓室及咽鼓管填塞封闭,以防止假鼻漏的情况发生;3颈内动脉岩段与鼓室及咽鼓管关系密切,脑脊液耳漏修补手术中应避免手术误伤或骨折片意外伤及颈内动脉。
Objective To explore the skills and tactics of intractable cerebrospinal fluid otorhinism after traumatic brain injury. Methods The operative approach was performed in 11 patients with cerebrospinal fluid otorrhea and conservative treatment ineffective after middle skull base-mastoid process in 11 patients with craniocerebral trauma. Results 1 without mastoid probing 5 cases. Due to mastoid comminuted fracture, titanium plate fixation was performed in 2 cases before removal of the bone flap. In addition, 4 cases of mastoid fracture serious, intraoperative preoperative collection of skull debris back into the mastoid defect, take the longest muscle plus bio-plastic reinforcement; 2 found in a skull base extensive bone defects in 6 cases, Brain tissue hernia into the defect or mastoid mucosa exposed extensively; 3 repair exploration found that the integrity of the ossicular chain in 3 cases, the absence of 2 cases, part of the hearing of the small bone (malleus) was missing in 2 cases, intraoperative exploration of the ossicular chain 4 example. Follow-up 2 to 11 years, no recurrence. Conclusions 1 When combined with complex fractures, through the combination of supratentorial and supratentorial mid-skull base-mastoid posterior combined approach, it is undoubtedly a wise choice, especially in unstable fractures involving mastoid; 2 pairs of skull base In addition to the closure of the external auditory canal, patients with cerebrospinal fluid otorrhea with complicated fracture and complete loss of hearing need to be closed with tympanic tube and eustachian tube to prevent false rhinorrhea. 3 The internal carotid artery segment is closely related to the tympanic cavity and eustachian tube , Cerebrospinal fluid otorrhea surgery should avoid surgical injury or fracture accidental injury of the carotid artery.