摘要：

目的: 探讨新生儿颅骨凹陷骨折的手术方式。方法与结果: 纳入2021年1月至2023年12月在山东大学附属儿童医院进行手术治疗的8例新生儿颅骨凹陷骨折患儿，术前均行头部CT薄层扫描+颅骨三维重建，根据凹陷部位、范围和深度，分别予以凹陷边缘钻孔，骨撬撬起凹陷颅骨复位（3例）；骨撬撬起后凹陷颅骨再次塌陷，延长切口显露全部凹陷区域，将塑形后的可吸收连接片固定于撬起后复位的凹陷区域（2例）；前囟外侧角处钝性分离颅骨和硬脑膜，深入骨撬撬起凹陷颅骨复位（1例）；凹陷边缘冠状缝处钝性分离颅骨和硬脑膜，深入骨撬撬起凹陷颅骨复位（2例）。术后第1天复查头部CT均显示凹陷复位良好。1例合并凹陷区域外线性骨折患儿骨折自然愈合，1例合并硬膜外出血患儿血肿自行吸收。平均随访6.80个月，复查头部CT均显示颅骨发育正常，无再次颅骨凹陷。结论: 手术治疗可以即刻复位颅骨凹陷骨折，对于邻近前囟或骨缝的骨折，可以通过前囟外侧角或未闭合的骨缝撬起凹陷，这一术式更为微创。

关键词: 颅骨骨折, 婴儿，新生, 神经外科手术

Abstract:

Objective: To explore the surgical treatment of depressed fracture of skull in neonates. Methods and Results: Eight neonates with depressed fracture of skull who underwent surgery in Children's Hospital Affiliated to Shandong University from January 2021 to December 2023 were included, and all of them underwent CT thin-slice scan + 3D reconstruction of skull before surgery. According to the location, extent and depth of the depression, the depressed edge was drilled and the depressed skull was reduced by bone pry (3 cases). The depressed skull collapsed again after the bone was pried up, the skin incision was extended to reveal the depressed area, and the shaped absorbable connector was fixed in the depressed area after prying up (2 cases). Blunt separation of the skull and dura mater at the lateral corner of the anterior fontanelle, and deep bone pry to pry up the depressed skull for reduction (one case). The skull and dura mater were bluntly separated from the coronal suture at the edge of the depression, and the depressed skull was pried up and reduced by deep bone pry (2 cases). On the first day after surgery, the reexamination of CT thin-slice scan + 3D reconstruction of skull showed that the depression reduction was satisfactory. Spontaneous fracture healing was happened in one case with linear fractures; hemorrhage resorption spontaneously was happened in one case with epidural hematoma. The average follow-up was 6.80 months, and the re-examination of CT thin-slice scan + 3D reconstruction of skull showed that the skull development was normal and there was no re-depression. Conclusions: Immediate reduction of depressed fracture of skull can be achieved with surgery, and for fractures close to the anterior fontanelle or suture, the depression can be prying up through the lateral angle of the anterior fontanelle or the unclosed suture, which is more minimally invasive.

Key words: Skull fractures, Infant, newborn, Neurosurgical procedures