摘要：

目的: 探讨非火器类异物致颅脑贯通伤的规范化救治策略。方法: 回顾分析2017年1月至2024年6月江西省赣州市人民医院收治的16例非火器类异物致颅脑贯通伤患者的临床资料，根据异物部位及影像学特征分别实施开颅异物取出术（10/16）、神经导航辅助下开颅异物取出术（4/16）或经鼻内镜下异物取出术（2/16）。术后24 ~ 48 h采用CT或MRI评估有无异物残留，术后7 d内采用CTA或DSA评估血管保护效果；记录围手术期并发症；术后90 d采用Glasgow预后分级评估神经功能预后。结果: 异物入颅部位经眶部7例、经额部4例、经顶部3例、经鼻2例，均成功完成手术。术后24 ~ 48 h影像学检查异物清除率达15/16，术后7 d内CTA或DSA无新发血管损伤；围手术期新发神经功能缺损3例、迟发性外伤性颅内血肿1例、脑脊液鼻漏2例、癫痫发作1例、颅内感染2例及脑脓肿1例，经针对性干预达临床治愈；术后90 d神经功能恢复良好10例、中残4例、重残2例，无死亡或植物状态生存。结论: 非火器类异物致颅脑贯通伤需多学科协作，结合影像学评估和个性化手术策略，早期清除异物、严密修补硬脑膜和强化抗感染管理是改善预后的关键。

关键词: 头部损伤，穿透性, 异物, 神经外科手术, 神经导航, 神经内窥镜, 预后

Abstract:

Objective: To explore the standardized treatment strategies for craniocerebral penetrating injury caused by non-firearm foreign body. Methods: A retrospective analysis was performed on the clinical data of 16 patients with non-firearm foreign body craniocerebral penetrating injury treated at Ganzhou People's Hospital from January 2017 to June 2024. Based on the foreign body location and imaging characteristics, personalized surgical interventions were carried out, including craniotomy for foreign body removal (10/16), neuronavigation-assisted removal (4/16), and endonasal endoscopic removal (2/16). The presence of residual foreign bodies was assessed within 24-48 h postoperatively by CT or MRI, vascular protection was evaluated within 7 d after surgery by CTA or DSA, and perioperative complications were recorded. Neurological functional prognosis was assessed using the Glasgow Outcome Scale (GOS) at 90 d postoperatively. Results: The entry sites of foreign bodies included the orbital compartment (7 cases), frontal region (4 cases), parietal region (3 cases), and nasal region (2 cases). All the 16 patients successfully underwent surgery. The clearance rate of foreign bodies within 24-48 h postoperatively reached 15/16. CTA or DSA performed within 7 d after surgery revealed no new blood vascular injury. Perioperative complications included new neurological deficits (3 cases), delayed traumatic intracranial hematoma (one case), cerebrospinal fluid rhinorrhea (2 cases), epileptic seizure (one case), intracranial infection (2 cases), and brain abscess (one case); all were alleviated after targeted intervention. At 90 d postoperatively, 10 patients had achieved good recovery (GOS score 5), 4 had moderate disability (GOS score 4), and 2 had severe disability (GOS score 3); there were no cases of death or vegetative state. Conclusions: The management of non-firearm foreign body craniocerebral penetrating injury should be based on multidisciplinary collaboration, combined with precise imaging evaluation and individualized surgical strategies. Early removal of the foreign body, rigorous cerebral dura mater repair, and intensified antinfective management are crucial for optimizing outcomes.

Key words: Head injuries, penetrating, Foreign bodies, Neurosurgical procedures, Neuronavigation, Neuroendoscopes, Prognosis