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目的探讨“滑动骨瓣”术式应用于儿童开颅手术的可行性。方法术前精确设计骨瓣大小及切口形状,术中使用线锯切下骨瓣,切面呈斜形,不再咬大骨窗。关颅前分离骨窗周边的帽状腱膜下与颅骨骨膜之间隙,将骨瓣埋置于骨窗边帽状腱膜下,在骨瓣相应位置钻2枚小孔,穿入10号丝线,从皮肤切口处引出备牵拉用。缝合头皮,术后5￣7d高颅压消退不需要骨窗减压时,牵拉骨瓣至骨窗处,使之完全复位。结果29例病人均一次复位成功,无一例感染,无并发牵拉部位血肿,骨瓣复位良好,术后半年以上者出现骨性愈合。结论“滑动骨瓣”术式用于儿童开颅手术是安全、有效的,可免去骨瓣减压术后二期颅骨成形术。
Objective To investigate the feasibility of “sliding flap” surgical craniotomy in children. Methods Preoperative accurate design of the size of the bone flap and the shape of the incision, intraoperative use of wire saw cut off the flap, the section was oblique, no longer bite the big window. Separation of cranial bone around the cranial perforator skull aponeurosis and the gap between the skull periosteum, the bone flap embedded in the bone window under the hatched aponeurosis, the corresponding position in the bone drill two holes, into the No. 10 thread , Lead from the skin incision draw with traction. Suture scalp, 5 ~ 7d after intracranial pressure subsidence does not require decompression of bone window, pulling the bone to the bone window, so that the complete reset. Results All the 29 patients were successfully reset with no case of infection. No hematoma was found in the traction site. The bone flap was well reset and the bony union occurred more than half a year after operation. Conclusions The “sliding flap” operation is safe and effective for craniotomy in children. It can eliminate the second stage skull plasty after decompressive craniectomy.