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目的:回顾分析面中部骨折伴外伤性脑脊液鼻漏的诊断以及同期治疗的手术方法。方法:选择2003年1月—2010年5月本院收治的脑外伤病例中脑挫裂伤、颅内血肿、原发性脑干损伤等脑外伤病情趋于稳定后仍存在脑脊液鼻漏的患者163例,对其发病年龄、致伤原因、住院天数、骨折特点、诊断及手术方法等进行分析。结果:163例行同期手术的患者中,术后1周脑脊液鼻漏消失者占全部病例的88.96%,2～3周后脑脊液鼻漏消失者占10.43%,仅有1例术后2周因颅内感染死亡;4例面神经颞支损伤,2例出现头皮麻木和感觉异常者,术后半年至1年症状消失;13例出现颞窝凹陷;所有患者术后咬合关系及开口度均恢复正常,面部外形基本对称。结论:同期处理面中部骨折与脑脊液鼻漏符合保守治疗超过1周即可行脑脊液鼻漏修补的原则,且可利用同一软组织切口进行手术,避免了分次手术的二次创伤,缩短了住院时间,节省了患者的治疗成本,减少了并发症的发生。同期治疗可使两者相得益彰,部分面中部骨折的复位固定可在一定意义上促进脑脊液鼻漏的恢复。
Objective: To retrospectively analyze the diagnosis of midfacial fractures associated with traumatic cerebrospinal fluid rhinorrhea and surgical treatment of the same period. Methods: From January 2003 to May 2010, patients with traumatic cerebrospinal fluid rhinorrhea after cerebral contusion, intracranial hematoma, primary brain stem injury and other traumatic brain injury in our hospital were stabilized. 163 cases were analyzed for their age of onset, causes of injury, length of hospital stay, fracture characteristics, diagnosis and surgical methods. Results: Of the 163 patients who underwent simultaneous surgery, the percentage of patients with cerebrospinal fluid rhinorrhea disappeared at 1 week after operation was 88.96% in all cases, and 10.43% of patients with cerebrospinal fluid rhinorrhea disappeared after 2 to 3 weeks. Only 1 patient Intracranial infection and death; 4 cases of facial nerve injury of the temporal branch, 2 cases of scalp numbness and sensory abnormalities, 6 months to 1 year after symptoms disappeared; 13 cases of temporal recess; all patients occlusal relationship and the opening were normal , The basic facial shape symmetry. Conclusions: In the same period, the treatment of midfacial fractures and cerebrospinal fluid rhinorrhea conservative treatment for more than 1 week can be the principle of cerebrospinal fluid rhinorrhea repair, and can use the same soft tissue incision for surgery, to avoid secondary trauma of graded surgery and reduce hospitalization time, Save the patient’s treatment costs and reduce the incidence of complications. The same period of treatment can make both complement each other, part of the reduction and fixation of midfacial fractures can promote the recovery of cerebrospinal fluid rhinorrhea in a certain sense.