探讨钻孔撬复法和骨瓣开颅复位法两种手术方法在小儿颅骨凹陷性骨折手术治疗中的应用。

选取自2013年1月至2015年12月吉林大学第一医院神经创伤外科收治的手术治疗小儿颅骨凹陷性骨折的66例患儿资料。其中，男性患儿42例，女性患儿24例，年龄1个月至13岁（平均年龄3.71岁）。从年龄受伤机制、手术方法的选择、术后恢复情况及随访等方面对小儿颅骨凹陷性骨折的手术治疗进行分析。并比较钻孔撬复法（A组，33例）和骨瓣开颅复位法（B组，33例）两种手术方法在小儿颅骨凹陷性骨折手术治疗中的应用。应用χ²检验及秩和检验进行统计学分析。以P<0.05为差异具有统计学意义。

66例患儿中，受伤机制以坠落伤和车祸伤为主：其中坠落伤18例（27.3%），车祸18例（27.3%）。按年龄不同将所有66例病例分为<1岁、1~6岁和6~13岁组。各组间受伤机制差异有统计学意义（χ²=15.349，P<0.05），坠落伤和打伤在不同年龄段的分布不同，差异有统计学意义（P<0.05）；<1岁组患儿坠落伤发生率明显高于1~6岁组患儿（P<0.01）。受伤部位以顶部最多，共31例，其次是颞顶11例和额部10例。笔者对钻孔撬复术和骨瓣开颅复位术两种手术方法的选择进行了比较，两组间患儿在性别上差异无统计学意义（χ²=2.262，P=0.609）。A组以2岁以内的患儿为主[中位数（四分位数间距）：0.92（2.92）]；B组以2岁以上的患儿为主[中位数（四分位数间距）：5（4.54）]，两组的患儿年龄具有明显差异（Z=-3.849，P<0.001）。实施钻孔撬复法的平均手术时间为40 min，短于实施开颅复位法（平均时间为1.5 h）。

小儿颅骨凹陷性骨折如满足以下条件，即<2岁，受伤时间<2周的，仅仅需要处理骨折，或者仅有少量硬膜外血肿可以从骨孔处清除并且无活动性出血的小儿颅骨凹陷性骨折的患儿，首选钻孔撬复术。

To investigate the application of two kinds of operation methods, drilling and prising elevation technique and trans-craniotomic elevation technique, in the treatment of the depressed skull fracture of pediatric patients.

We retrospectively evaluated pediatric patients with depressed skull fracture from January 2013 to December 2015 treated by neurosurgery approach in our hospital. There are 66 cases meet standard, male are 42 cases and female are 24 cases, which the ages range from 1 month to 13 years (mean interval: 3.71 years). We evaluated these cases from age, sex, mechanism of injury, location, surgery method and follows. Comparision was made between individuals who were treated by drilling and prising elevation technique (group A, n=33), and those surgically treated by trans-craniotomic elevation technique (group B, n=33). χ² test and rank-sum test was used in this study. There are significantly different when P<0.05.

In these cases, Fall and traffic accident are two main mechanisms of injury: Fall (18 cases, 27.3%), traffic accident(18 cases, 27.3%). There are significantly deferent in the mechanisms between <1 year group, 1-6 years group and 6-13 years group (χ²=15.349, P<0.05). Fall and violence are significantly deferent between these groups (P<0.01); the population of fall in the <1 year group is significant more than 1~6 years group(P<0.01). Parietal bone is the highest rate of injuries location (31 cases), the other two high rate of injuries location are temporal bone and frontal bone. There is no deferent in sex between group A (drilling and prising elevation technique) and group B (trans-craniotomic elevation technique) (χ²=2.262, P=0.609). The age at the time of evaluation was significantly younger in A group(Median(IQR): 0.92(2.92) years, P<0.001) compared with B group (Median(IQR): 5(4.54) years).

The drilling and prising elevation technique is recommended for the depressed skull fracture of pediatric patients younger than 2 years old and injury short than 2 weeks, who are simple depressed skul fractures or complicated with less significant epidural hematoma.