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目的 探讨小儿外伤后硬脑膜下积液的外科治疗 ,同时介绍一种蛛网膜造瘘和颞肌填塞的手术治疗方法。方法 12例外伤性硬脑膜下积液患儿中 3例给予单纯钻孔引流术 ,3例在接受多次单孔引流术后因复发而接受蛛网膜造瘘及颞肌填塞手术 ,另 6例患儿直接给予蛛网膜造瘘及颞肌填塞手术治疗 ;蛛网膜造瘘及颞肌填塞治疗的方法为 :在基础及局麻下 ,于患侧颞部做 4cm长深达骨膜的皮肤直切口并牵开 ,颅骨钻孔一枚后扩大成直径 3cm的骨窗 ,电烙切开骨窗下的硬脑膜 ,缓慢放出硬脑膜下积液 ;在蛛网膜上做一小的撕裂口 ;制取术野 2cm宽的带蒂颞肌瓣 ,做适当的剪裁延长并严密止血后 ,将其游离段经骨孔置入硬脑膜下腔并在骨窗处适当固定。结果 3例患儿在单纯钻孔引流术后一次治愈 ;3例经多次钻孔引流失败者及另 6例患儿均在一次性蛛网膜造瘘及颞肌填塞手术后治愈。结论 蛛网膜造瘘及颞肌填塞术是一种治疗外伤性硬脑膜下积液的实用方法 ,其操作简单 ,并发症少 ,效果理想。
Objective To investigate the surgical treatment of subdural effusion after pediatric trauma and to introduce a surgical treatment of arachnoid fistula and temporal muscle blockage. Methods Thirteen patients with traumatic subdural effusion were given simple drilling and drainage. Three patients received arachnoid fistula and temporal muscle plug operation due to recurrence after receiving multiple single-hole drainage. Another 6 patients Pediatric patients were directly given arachnoid fistula and temporal muscle flap surgery; arachnoid fistula and temporal muscle packing treatment method is: under the foundation and local anesthesia, in the affected side of the temporal 4cm deep periosteum skin straight incision And retraction, a hole in the skull to expand into a 3cm diameter bone window, electrocautery cut open the dura under the bones, slowly release subdural effusion; do a small tear in the arachnoid; Taken surgery 2cm wide pedicled temporal muscle flap, do the appropriate extension of the cut and tight hemostasis, the free part of the hole into the subdural cavity and bone window at the appropriate fixed. Results Three children were cured after simple drilling and drainage. Three patients who failed multiple drainage and drainage and the other six patients were cured after one-time arachnoid ostomy and temporal muscle plug operation. Conclusion Arachnoid fistula and temporal muscle obstruction is a practical method for the treatment of traumatic subdural effusion. Its operation is simple, the complication is less and the effect is satisfactory.