山东大学耳鼻喉眼学报 ›› 2022, Vol. 36 ›› Issue (1): 13-19.doi: 10.6040/j.issn.1673-3770.0.2021.436

• • 上一篇    下一篇

儿童颞骨骨折临床特点和治疗策略

马宁1,2,陈敏1,2,刘薇1,2,杨扬1,2,邵剑波1,2,郝津生1,2,刘冰1,2,张晓1,2,段晓岷3,张祺丰3,张杰1,2   

  1. 1.国家儿童医学中心/首都医科大学附属北京儿童医院 耳鼻咽喉头颈外科, 北京 100045;
    2.儿童耳鼻咽喉头颈外科疾病北京市重点实验室, 北京 100045;
    3.国家儿童医学中心/首都医科大学附属北京儿童医院 影像中心, 北京 100045;
  • 出版日期:2022-01-10 发布日期:2022-02-22
  • 通讯作者: 张杰. E-mail:stzhangj@263.net
  • 基金资助:
    北京市医院管理中心儿科学科协同发展中心专项经费资助(XTYB201828);北京市医院管理中心“登峰”计划(DFL20191201)

Clinical characteristics and management of pediatric temporal bone fractures

MA Ning1,2, CHEN Min1,2, LIU Wei1,2, YANG Yang1,2, SHAO Jianbo1,2, HAO Jinsheng1,2, LIU Bing1,2, ZHANG Xiao1,2, DUAN Xiaomin3, ZHANG Qifeng3, ZHANG Jie1,2   

  1. 1. Department of Otorhinolaryngology & Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China;
    2. Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing 100045, China;
    3. Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
  • Online:2022-01-10 Published:2022-02-22

PDF (PC)

414

摘要： 目的 探讨儿童颞骨骨折的临床特点及治疗策略。 方法 回顾性分析2014年7月~2021年7月首都医科大学附属北京儿童医院确诊的477例18岁以下颞骨骨折患儿的临床资料,包括患儿性别、年龄、受伤原因、影像学、面神经及听力学评估、并发症、治疗及预后。 结果 477例颞骨骨折患儿中男358例、女119例,男女比例为3∶1,年龄范围为0~18岁,中位年龄9岁,其中6例为双侧。交通事故是受伤主要原因(57.23%),其次为跌倒(23.69%)。最常见的临床症状为鼓室积血和耳出血,通常3周~1个月消失。纵行骨折253耳(52.38%),横行骨折35耳(7.25%),混合型骨折48耳(9.93%),其他不能进行分型147耳(30.43%),表现为轻微骨折线。听力受损372例(77.02%);面神经损伤28例(5.80%),其中8例为内听道及以上层面损伤;脑脊液耳漏47例(9.73%);鼓膜穿孔15例(3.11%)。合并颅内损伤78例(16.35%),全身多发损伤19例(3.98%)。即发性面瘫10例,1例恢复良好(10.00%);迟发性面瘫18例,15例恢复良好(83.33%)。耳科并发症的处理经手术治疗10例,包括8例鼓室探查+听骨链重建,术后听阈恢复正常。2例面神经减压术,术后House-Brackmann面神经功能分级(HB分级)Ⅴ级恢复至Ⅱ级。 结论 儿童颞骨骨折中,男童常见,最常见的受伤原因为交通事故。鼓室积血、鼓膜穿孔、脑脊液耳漏和传导性耳聋经保守治疗多可治愈,外伤所致听骨链骨折或脱位经手术治疗预后良好,外伤所致内听道区域骨折可引起极重度感音神经性耳聋和完全性面瘫,预后较差。

关键词: 颞骨骨折, 儿童, 面神经损伤, 听力损失, 脑脊液耳漏

Abstract: Objective To summarize the clinical characteristics and treatment strategies of temporal bone fracture in children. Methods Medical records of 477 children under 18 years old who were diagnosed with temporal bone fracture in Beijing Children's Hospital from July 2014 to July 2021 were retrospectively analyzed. Including age, gender, injury causes, imaging, facial nerve and audiological assessment, complications, treatment and prognosis. Results 483 sides of 477 children,6 of which were bilateral. The age range was from birth to 18 years old, the median age was 9 years old, and the male to female ratio was 3.01∶1. Traffic accidents were the main cause of injuries, accounting for 57.23%, followed by falls, accounting for 23.69%. The most common clinical symptoms are tympanema and ear hemorrhage, which usually disappear from 3 weeks to 1 month. Longitudinal fracture accounted for 52.38%, transverse fracture 35, 7.25%; 48 cases of mixed fracture, accounting for 9.93%, and 147 cases, accounting for 30.43%, which could not be classified, were presented as minor fracture lines.372 cases(77.02%)had hearing impairment. Facial nerve injury occurred in 28 cases(5.80%), including 8 cases of internal auditory canal injury. Cerebrospinal fluid otorrhea(CSF)was found in 47 cases(9.73%). Tympanic membrane perforation occurred in 15 cases(3.11%). 6.35% with intracranial injury. 3.98% complicated with multiple fractures or multiple organ injuries. There were 10 cases of immediate facial paralysis, 1 case recovered well, accounting for 10.00%, and 18 cases of delayed facial paralysis, 15 cases recovered well, accounting for 83.33%. 10 cases were treated by operation, including 8 cases of tympanum exploration and ossicular chain reconstruction. Facial nerve HB Ⅴ was recovered to HB Ⅱafter decompression in 2 cases. Conclusion Temporal bone fracture in children is most common in boys, and the most common cause of injury is traffic accident. Tympanic hemorrhage, tympanic membrane perforation, cerebrospinal fluid otorrhea and conductive deafness can be cured by conservative treatment. Trauma caused ossicular chain fracture or dislocation has a good prognosis by surgical treatment. Trauma caused internal auditory canal fracture can cause extremely severe sensorineural deafness and complete facial paralysis with poor prognosis.

Key words: Temporal bone fracture, Pediatric, Facial nerve injury, hearing loss, Cerebrospinal fluid leak

中图分类号: 

  • R764.3
[1] Isaacson B. Anatomy and surgical approach of the ear and temporal bone[J]. Head Neck Pathol, 2018, 12(3): 321-327. doi:10.1007/s12105-018-0926-2.
[2] Brodie HA, Thompson TC. Management of complications from 820 temporal bone fractures[J]. Am J Otol, 1997, 18(2): 188-197.
[3] Chadha S, Kamenov K, Cieza A. The world report on hearing, 2021[J]. Bull World Health Organ, 2021, 99(4): 242-242A. doi:10.2471/blt.21.285643.
[4] 许嘉, 伊海金.正确处理颞骨骨折耳科并发症[J].山东大学耳鼻喉眼学报, 2020, 34(1): 4-8.doi:10.6040/j.issn.1673-3770.1.2019.048. XU Jia, YI Haijin. Standardized treatment of auricular complications with temporal bone fractures[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 4-8. doi:10.6040/j.issn.1673-3770.1.2019.048.
[5] Sonya Wexler, Erica Poletto, Sri Kiran Chennupati.Pediatric Temporal Bone Fractures: A 10-Year Experience[J].Pediatric emergency care, 2017, 33(11):745-747.
[6] Kanona H, Anderson C, Lambert A, et al. A large case series of temporal bone fractures at a UK major trauma centre with an evidence-based management protocol[J]. J Laryngol Otol, 2020, 134(3): 205-212. doi:10.1017/s0022215120000419.
[7] Lee D, Honrado C, Har-El G, et al. Pediatric temporal bone fractures[J]. Laryngoscope, 1998, 108(6): 816-821. doi:10.1097/00005537-199806000-00008.
[8] Wexler S, Poletto E, Chennupati SK. Pediatric temporal bone fractures: a 10-year experience[J]. Pediatr Emerg Care, 2017, 33(11): 745-747. doi:10.1097/PEC.0000000000000594.
[9] Brodie HA, Thompson TC. Management of complications from 820 temporal bone fractures[J]. Am J Otol, 1997, 18(2): 188-197.
[10] Ort S, Beus K, Isaacson J. Pediatric temporal bone fractures in a rural population[J]. Otolaryngol Head Neck Surg, 2004, 131(4): 433-437. doi:10.1016/j.otohns.2004.04.006.
[11] Ulug T, Arif Ulubil S. Management of facial paralysis in temporal bone fractures: a prospective study analyzing 11 operated fractures[J]. Am J Otolaryngol, 2005, 26(4): 230-238. doi:10.1016/j.amjoto.2005.01.004.
[12] Ahmet Erim Pamuk, Gözde Pamuk, Münir Demir Bajin, et al.Traumatic Facial and Vestibulocochlear Nerve Injury in The Internal Acoustic Canal in The Absence of A Temporal Bone Fracture[J].The journal of international advanced otology, 2018, 14(2):330-333.
[13] Corrales CE, Monfared A, Jackler RK. Facial and vestibulocochlear nerve avulsion at the fundus of the internal auditory canal in a child without a temporal bone fracture[J].Otol Neurotol, 2010, 31(9):1508-1510. doi:10.1097/mao.0b013e3181f0c848.
[14] Kang HM, Kim MG, Hong SM, et al. Comparison of temporal bone fractures in children and adults[J]. Acta Otolaryngol, 2013, 133(5): 469-474. doi:10.3109/00016489.2012.754995.
[15] Montava M, Mancini J, Masson C, et al. Temporal bone fractures: sequelae and their impact on quality of life[J]. Am J Otolaryngol, 2015, 36(3): 364-370. doi:10.1016/j.amjoto.2014.12.011.
[16] Perheentupa U, Kinnunen I, Grénman R, et al. Management and outcome of pediatric skull base fractures[J]. Int J Pediatr Otorhinolaryngol, 2010, 74(11): 1245-1250. doi:10.1016/j.ijporl.2010.07.023.
[17] 倪鑫, 张天宇. 实用儿童耳鼻咽喉头颈科学[M]. 2版. 北京: 人民卫生出版社, 2021.
[1] 王敏,刘皓,姜露涵,谭立约,李文,付小龙. AAV-ie-Tnfaip8l2的包装及其对Tnfaip8l2-/-小鼠听觉功能的改善效果[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 7-15.
[2] 朱希倩,王佳,孙祖贤,冯建秀,张梦佳,赵颖,王宏,姜敏敏. 上海市杨浦区2022—2024年6~9岁学龄儿童屈光状态分析[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 102-109.
[3] 王梦慧,黎奥,魏浩,姜玥,吴星光,李鹿晞,钱晓云. 乙型肝炎病毒致聋多机制与临床预警[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 110-114.
[4] 王凯健,王威,陈雪生,樊春笋,何颖颖,黄冬玲,钱村慧,丁树军. 中性粒淋巴细胞比值与成年人听力损失及听力阈值的关系:基于NHANES数据库的横断面研究[J]. 山东大学耳鼻喉眼学报, 2026, 40(2): 18-28.
[5] 陶朵朵,史彬,赵云舒,李勇刚,刘济生. 年龄相关性听力损失患者前扣带回神经递质水平及其与听力水平关系的初步研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 31-39.
[6] 宋艳玲,司元元,崔彦. 微量玻璃体切除治疗激光笔致儿童全层黄斑裂孔1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 144-147.
[7] 刘南仙,杨泽垠,韩琳,张爱英,赵宇亮,薛静,孙怡君,邵永良. 视频脑电图在儿童复发性眩晕诊断中的意义[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 20-25.
[8] 黄焕,华红利,邓玉琴,江承洋,王雨薇,杨星海. 儿童过敏性鼻炎、扁桃体腺样体肥大和鼻窦炎之间相关性及其对临床指导价值[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 34-41.
[9] 王华,张丰珍,龙婷,赵靖,李宏彬,王生才,王桂香. 后颅窝肿瘤术后儿童气管切开原因及预后转归分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 168-173.
[10] 乐冰艳,邹剑,雷蕾,文巧,钱应雪. 儿童扁桃体微生物群与免疫调节及疾病关联[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 193-200.
[11] 张丽霞,李琳. 基于GEO数据库筛选年龄相关性听力损失关键基因的分析研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 104-114.
[12] 黄爱萍,王娟,王丽,耿江桥,王亚芳,温鑫. 儿童原发扁桃体Burkitt淋巴瘤累及上颌骨和肺1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 148-152.
[13] 刘畅,杨景朴,高雨,王文佳. 长春地区儿童变应性鼻炎变应原检测结果分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 51-58.
[14] 付圣尧,陈敏,庞文会,李娜. 内镜辅助个体化手术入路治疗儿童鼻中线囊肿及瘘管[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 65-71.
[15] 陈丹萍,何子键,虞幼军,周晓娓. 儿童突发性聋10年住院病例的疗效及预后相关因素分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 16-22.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发