颅骨骨折

闭合性非凹陷型骨折的治疗主要是保守疗法。保守治疗包括观察以排除任何进行性并发症（例如脑脊液漏、癫痫发作或感染）。

药物干预（例如抗惊厥药物和抗生素预防法）通常不用于孤立性颅骨骨折患者。几乎没有确切证据表明抗生素能够降低伴有或无脑脊液漏情况下的脑膜炎或其他感染风险。[48]Demetriades D, Charalambides D, Lakhoo M, et al. Role of prophylactic antibiotics in open and basilar fractures of the skull: a randomized study. Injury. 1992;23:377-380.http://www.ncbi.nlm.nih.gov/pubmed/1428162?tool=bestpractice.com[49]Ratilal B, Costa J, Pappamikail L, et al. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev. 2015;(4):CD004884.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004884.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25918919?tool=bestpractice.com[50]Rehman L, Ghani E, Hussain A, et al. Infection in compound depressed fracture of the skull. J Coll Physicians Surg Pak. 2007;17:140-143.http://www.ncbi.nlm.nih.gov/pubmed/17374298?tool=bestpractice.com[51]Nellis JC, Kesser BW, Park SS. What is the efficacy of prophylactic antibiotics in basilar skull fractures? Laryngoscope. 2014;124:8-9.http://onlinelibrary.wiley.com/doi/10.1002/lary.23934/fullhttp://www.ncbi.nlm.nih.gov/pubmed/24122671?tool=bestpractice.com证据 A感染性并发症和脑脊液漏的减少：源自对 5 项随机对照试验的 Cochrane 综述和包含 2,000 多名患者的 17 项非随机试验的合并数据的高质量证据表明，使用预防性抗生素在降低脑膜炎发病率、脑膜炎相关的死亡率或总体死亡率方面并没有比不使用抗生素更有效。[49]Ratilal B, Costa J, Pappamikail L, et al. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev. 2015;(4):CD004884.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004884.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25918919?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。一些数据支持对颅底骨折儿童使用肺炎球菌疫苗。[48]Demetriades D, Charalambides D, Lakhoo M, et al. Role of prophylactic antibiotics in open and basilar fractures of the skull: a randomized study. Injury. 1992;23:377-380.http://www.ncbi.nlm.nih.gov/pubmed/1428162?tool=bestpractice.com[50]Rehman L, Ghani E, Hussain A, et al. Infection in compound depressed fracture of the skull. J Coll Physicians Surg Pak. 2007;17:140-143.http://www.ncbi.nlm.nih.gov/pubmed/17374298?tool=bestpractice.com

闭合性凹陷型骨折的治疗主要是保守治疗；手术抬高和修补在降低癫痫发作、感染或神经系统功能障碍风险方面的作用极小。

保守治疗包括观察以排除任何进行性并发症（例如脑脊液漏、癫痫发作或感染）。药物干预（例如抗惊厥药物和抗生素预防法）通常不用于孤立性颅骨骨折患者。几乎没有确切证据表明抗生素能够降低伴有或无脑脊液漏情况下的脑膜炎或其他感染风险。[48]Demetriades D, Charalambides D, Lakhoo M, et al. Role of prophylactic antibiotics in open and basilar fractures of the skull: a randomized study. Injury. 1992;23:377-380.http://www.ncbi.nlm.nih.gov/pubmed/1428162?tool=bestpractice.com[49]Ratilal B, Costa J, Pappamikail L, et al. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev. 2015;(4):CD004884.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004884.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25918919?tool=bestpractice.com[50]Rehman L, Ghani E, Hussain A, et al. Infection in compound depressed fracture of the skull. J Coll Physicians Surg Pak. 2007;17:140-143.http://www.ncbi.nlm.nih.gov/pubmed/17374298?tool=bestpractice.com[51]Nellis JC, Kesser BW, Park SS. What is the efficacy of prophylactic antibiotics in basilar skull fractures? Laryngoscope. 2014;124:8-9.http://onlinelibrary.wiley.com/doi/10.1002/lary.23934/fullhttp://www.ncbi.nlm.nih.gov/pubmed/24122671?tool=bestpractice.com证据 A感染性并发症和脑脊液漏的减少：源自对 5 项随机对照试验的 Cochrane 综述和包含 2,000 多名患者的 17 项非随机试验的合并数据的高质量证据表明，使用预防性抗生素在降低脑膜炎发病率、脑膜炎相关的死亡率或总体死亡率方面并没有比不使用抗生素更有效。[49]Ratilal B, Costa J, Pappamikail L, et al. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev. 2015;(4):CD004884.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004884.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25918919?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。一些数据支持对颅底骨折儿童使用肺炎球菌疫苗。[48]Demetriades D, Charalambides D, Lakhoo M, et al. Role of prophylactic antibiotics in open and basilar fractures of the skull: a randomized study. Injury. 1992;23:377-380.http://www.ncbi.nlm.nih.gov/pubmed/1428162?tool=bestpractice.com[50]Rehman L, Ghani E, Hussain A, et al. Infection in compound depressed fracture of the skull. J Coll Physicians Surg Pak. 2007;17:140-143.http://www.ncbi.nlm.nih.gov/pubmed/17374298?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

创伤后癫痫 (PTS) 常见于重度外伤性脑损伤后，但即使是轻度至中度脑损伤，其 PTS 风险也显著增加。[9]Al-Haddad SA, Kirollos R. A 5-year study of the outcome of surgically treated depressed skull fractures. Ann R Coll Surg Engl. 2002;84:196-200.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503833/pdf/annrcse01637-0060.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/12092875?tool=bestpractice.com[61]Liesemer K, Bratton SL, Zebrack CM, et al. Early post-traumatic seizures in moderate to severe pediatric traumatic brain injury: rates, risk factors, and clinical features. J Neurotrauma. 2011;28:755-762.http://www.ncbi.nlm.nih.gov/pubmed/21381863?tool=bestpractice.com[62]Beghi E. Overview of studies to prevent posttraumatic epilepsy. Epilepsia. 2003;44 Suppl 10:21-26.http://onlinelibrary.wiley.com/doi/10.1046/j.1528-1157.44.s10.1.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/14511391?tool=bestpractice.com有确凿证据支持抗癫痫药物 (AED) 的短期使用，特别是苯妥英。[61]Liesemer K, Bratton SL, Zebrack CM, et al. Early post-traumatic seizures in moderate to severe pediatric traumatic brain injury: rates, risk factors, and clinical features. J Neurotrauma. 2011;28:755-762.http://www.ncbi.nlm.nih.gov/pubmed/21381863?tool=bestpractice.com[63]Temkin NR. Preventing and treating posttraumatic seizures: the human experience. Epilepsia. 2009;50 Suppl 2:10-13.http://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2008.02005.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/19187289?tool=bestpractice.com[64]Chang BS, Lowenstein DH; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: antiepileptic drug prophylaxis in severe traumatic brain injury: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2003;60:10-16.http://www.neurology.org/content/60/1/10.full.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/12525711?tool=bestpractice.com然而，研究表明 AED 不能降低迟发型 PTS（≥ 8 天）或创伤后癫痫发作的风险，且不支持或建议在受伤后第一周之后使用该类药物。[9]Al-Haddad SA, Kirollos R. A 5-year study of the outcome of surgically treated depressed skull fractures. Ann R Coll Surg Engl. 2002;84:196-200.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503833/pdf/annrcse01637-0060.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/12092875?tool=bestpractice.com[61]Liesemer K, Bratton SL, Zebrack CM, et al. Early post-traumatic seizures in moderate to severe pediatric traumatic brain injury: rates, risk factors, and clinical features. J Neurotrauma. 2011;28:755-762.http://www.ncbi.nlm.nih.gov/pubmed/21381863?tool=bestpractice.com[62]Beghi E. Overview of studies to prevent posttraumatic epilepsy. Epilepsia. 2003;44 Suppl 10:21-26.http://onlinelibrary.wiley.com/doi/10.1046/j.1528-1157.44.s10.1.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/14511391?tool=bestpractice.com[63]Temkin NR. Preventing and treating posttraumatic seizures: the human experience. Epilepsia. 2009;50 Suppl 2:10-13.http://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2008.02005.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/19187289?tool=bestpractice.com[64]Chang BS, Lowenstein DH; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: antiepileptic drug prophylaxis in severe traumatic brain injury: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2003;60:10-16.http://www.neurology.org/content/60/1/10.full.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/12525711?tool=bestpractice.com除重度凹陷型颅骨骨折外，没有数据支持 AED 在无潜在脑损伤的孤立性颅骨骨折中早发型或迟发型 PTS 预防方面的使用。对持续存在癫痫发作并确诊患有创伤后癫痫发作的患者，其癫痫的治疗与非创伤性原因的癫痫治疗相似。[9]Al-Haddad SA, Kirollos R. A 5-year study of the outcome of surgically treated depressed skull fractures. Ann R Coll Surg Engl. 2002;84:196-200.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503833/pdf/annrcse01637-0060.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/12092875?tool=bestpractice.com[63]Temkin NR. Preventing and treating posttraumatic seizures: the human experience. Epilepsia. 2009;50 Suppl 2:10-13.http://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2008.02005.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/19187289?tool=bestpractice.com[64]Chang BS, Lowenstein DH; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: antiepileptic drug prophylaxis in severe traumatic brain injury: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2003;60:10-16.http://www.neurology.org/content/60/1/10.full.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/12525711?tool=bestpractice.com

因此，将考虑预防性抗惊厥治疗，并仅用于开放性凹陷型颅骨骨折或伴潜在脑损伤的骨折。但不适用于或不建议用于单纯性孤立性颅骨骨折。如果发生癫痫发作，可与任何非创伤性癫痫发作一样，用苯二氮卓类药物进行治疗，随后给予抗癫痫药物。

患者如出现骨折尺寸 ＞ 1 cm、影响美观的严重畸形、硬脑膜撕裂症状或可进行手术的相关颅内病变，则表明可进行硬脑膜修补术与颅骨成形术。任何患者如出现凹陷型骨折 ＞1 cm、影响美观的严重畸形、硬脑膜撕裂症状或可手术的相关颅内病变，则应考虑手术抬高和硬脑膜修补及颅骨成形术。[3]Ersahin Y, Mutluer S, Mirzai H, et al. Pediatric depressed skull fractures: analysis of 530 cases. Childs Nerv Syst. 1996;12:323-331.http://www.ncbi.nlm.nih.gov/pubmed/8816297?tool=bestpractice.com[9]Al-Haddad SA, Kirollos R. A 5-year study of the outcome of surgically treated depressed skull fractures. Ann R Coll Surg Engl. 2002;84:196-200.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503833/pdf/annrcse01637-0060.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/12092875?tool=bestpractice.com[41]Donovan DJ. Simple depressed skull fracture causing sagittal sinus stenosis and increased intracranial pressure: case report and review of the literature. Surg Neurol. 2005;63:380-383.http://www.ncbi.nlm.nih.gov/pubmed/15808730?tool=bestpractice.com[52]Kaptigau WM, Ke L, Rosenfeld JV. Open depressed and penetrating skull fractures in Port Moresby General Hospital from 2003 to 2005. P N G Med J. 2007;50:58-63.http://www.ncbi.nlm.nih.gov/pubmed/19354013?tool=bestpractice.com[53]Heary RF, Hunt CD, Krieger AJ, et al. Nonsurgical treatment of compound depressed skull fractures. J Trauma. 1993;35:441-447.http://www.ncbi.nlm.nih.gov/pubmed/8371305?tool=bestpractice.com[54]Marbacher S, Andres RH, Fathi AR, et al. Primary reconstruction of open depressed skull fractures with titanium mesh. J Craniofac Surg. 2008;19:490-495.http://www.ncbi.nlm.nih.gov/pubmed/18362730?tool=bestpractice.com[55]Bullock MR, Chesnut R, Ghajar J, et al; Surgical Management of Traumatic Brain Injury Author Group. Surgical management of depressed cranial fractures. Neurosurgery. 2006;58(3 suppl):S56-S60.http://www.ncbi.nlm.nih.gov/pubmed/16540744?tool=bestpractice.com

现有证据表明，开放性颅骨骨折如果无颅内出血、脑脊液漏或严重感染，则可以采取保守治疗。[53]Heary RF, Hunt CD, Krieger AJ, et al. Nonsurgical treatment of compound depressed skull fractures. J Trauma. 1993;35:441-447.http://www.ncbi.nlm.nih.gov/pubmed/8371305?tool=bestpractice.com保守治疗包括观察以排除任何进行性并发症（例如脑脊液漏、癫痫发作或感染）。

药物干预（例如抗惊厥药物和抗生素预防法）通常不用于孤立性颅骨骨折患者。几乎没有确切证据表明抗生素能够降低伴有或无脑脊液漏情况下的脑膜炎或其他感染风险。[48]Demetriades D, Charalambides D, Lakhoo M, et al. Role of prophylactic antibiotics in open and basilar fractures of the skull: a randomized study. Injury. 1992;23:377-380.http://www.ncbi.nlm.nih.gov/pubmed/1428162?tool=bestpractice.com[49]Ratilal B, Costa J, Pappamikail L, et al. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev. 2015;(4):CD004884.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004884.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25918919?tool=bestpractice.com[50]Rehman L, Ghani E, Hussain A, et al. Infection in compound depressed fracture of the skull. J Coll Physicians Surg Pak. 2007;17:140-143.http://www.ncbi.nlm.nih.gov/pubmed/17374298?tool=bestpractice.com[51]Nellis JC, Kesser BW, Park SS. What is the efficacy of prophylactic antibiotics in basilar skull fractures? Laryngoscope. 2014;124:8-9.http://onlinelibrary.wiley.com/doi/10.1002/lary.23934/fullhttp://www.ncbi.nlm.nih.gov/pubmed/24122671?tool=bestpractice.com证据 A感染性并发症和脑脊液漏的减少：源自对 5 项随机对照试验的 Cochrane 综述和包含 2,000 多名患者的 17 项非随机试验的合并数据的高质量证据表明，使用预防性抗生素在降低脑膜炎发病率、脑膜炎相关的死亡率或总体死亡率方面并没有比不使用抗生素更有效。[49]Ratilal B, Costa J, Pappamikail L, et al. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev. 2015;(4):CD004884.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004884.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25918919?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。一些数据支持对颅底骨折儿童使用肺炎球菌疫苗。[48]Demetriades D, Charalambides D, Lakhoo M, et al. Role of prophylactic antibiotics in open and basilar fractures of the skull: a randomized study. Injury. 1992;23:377-380.http://www.ncbi.nlm.nih.gov/pubmed/1428162?tool=bestpractice.com[50]Rehman L, Ghani E, Hussain A, et al. Infection in compound depressed fracture of the skull. J Coll Physicians Surg Pak. 2007;17:140-143.http://www.ncbi.nlm.nih.gov/pubmed/17374298?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

创伤后癫痫 (PTS) 常见于重度外伤性脑损伤后，但即使是轻度至中度脑损伤，其 PTS 风险也显著增加。[9]Al-Haddad SA, Kirollos R. A 5-year study of the outcome of surgically treated depressed skull fractures. Ann R Coll Surg Engl. 2002;84:196-200.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503833/pdf/annrcse01637-0060.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/12092875?tool=bestpractice.com[61]Liesemer K, Bratton SL, Zebrack CM, et al. Early post-traumatic seizures in moderate to severe pediatric traumatic brain injury: rates, risk factors, and clinical features. J Neurotrauma. 2011;28:755-762.http://www.ncbi.nlm.nih.gov/pubmed/21381863?tool=bestpractice.com[62]Beghi E. Overview of studies to prevent posttraumatic epilepsy. Epilepsia. 2003;44 Suppl 10:21-26.http://onlinelibrary.wiley.com/doi/10.1046/j.1528-1157.44.s10.1.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/14511391?tool=bestpractice.com有确凿证据支持抗癫痫药物 (AED) 的短期使用，特别是苯妥英。[61]Liesemer K, Bratton SL, Zebrack CM, et al. Early post-traumatic seizures in moderate to severe pediatric traumatic brain injury: rates, risk factors, and clinical features. J Neurotrauma. 2011;28:755-762.http://www.ncbi.nlm.nih.gov/pubmed/21381863?tool=bestpractice.com[63]Temkin NR. Preventing and treating posttraumatic seizures: the human experience. Epilepsia. 2009;50 Suppl 2:10-13.http://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2008.02005.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/19187289?tool=bestpractice.com[64]Chang BS, Lowenstein DH; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: antiepileptic drug prophylaxis in severe traumatic brain injury: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2003;60:10-16.http://www.neurology.org/content/60/1/10.full.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/12525711?tool=bestpractice.com然而，研究表明 AED 不能降低迟发型 PTS（≥ 8 天）或创伤后癫痫的风险，且不支持或建议在受伤后第一周之后使用该类药物。[9]Al-Haddad SA, Kirollos R. A 5-year study of the outcome of surgically treated depressed skull fractures. Ann R Coll Surg Engl. 2002;84:196-200.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503833/pdf/annrcse01637-0060.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/12092875?tool=bestpractice.com[61]Liesemer K, Bratton SL, Zebrack CM, et al. Early post-traumatic seizures in moderate to severe pediatric traumatic brain injury: rates, risk factors, and clinical features. J Neurotrauma. 2011;28:755-762.http://www.ncbi.nlm.nih.gov/pubmed/21381863?tool=bestpractice.com[62]Beghi E. Overview of studies to prevent posttraumatic epilepsy. Epilepsia. 2003;44 Suppl 10:21-26.http://onlinelibrary.wiley.com/doi/10.1046/j.1528-1157.44.s10.1.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/14511391?tool=bestpractice.com[63]Temkin NR. Preventing and treating posttraumatic seizures: the human experience. Epilepsia. 2009;50 Suppl 2:10-13.http://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2008.02005.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/19187289?tool=bestpractice.com[64]Chang BS, Lowenstein DH; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: antiepileptic drug prophylaxis in severe traumatic brain injury: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2003;60:10-16.http://www.neurology.org/content/60/1/10.full.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/12525711?tool=bestpractice.com除重度凹陷型颅骨骨折外，没有数据支持 AED 在无潜在脑损伤的孤立性颅骨骨折中早发型或迟发型 PTS 预防方面的使用。对持续存在癫痫发作并确诊患有创伤后癫痫的患者，其癫痫的治疗与非创伤性原因的癫痫治疗相似。[9]Al-Haddad SA, Kirollos R. A 5-year study of the outcome of surgically treated depressed skull fractures. Ann R Coll Surg Engl. 2002;84:196-200.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503833/pdf/annrcse01637-0060.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/12092875?tool=bestpractice.com[63]Temkin NR. Preventing and treating posttraumatic seizures: the human experience. Epilepsia. 2009;50 Suppl 2:10-13.http://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2008.02005.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/19187289?tool=bestpractice.com[64]Chang BS, Lowenstein DH; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: antiepileptic drug prophylaxis in severe traumatic brain injury: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2003;60:10-16.http://www.neurology.org/content/60/1/10.full.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/12525711?tool=bestpractice.com

因此，将考虑预防性抗惊厥治疗，并仅用于开放性凹陷型颅骨骨折或伴潜在脑损伤的骨折。但不适用于或不建议用于单纯性孤立性颅骨骨折。如果发生癫痫发作，可与任何非创伤性癫痫发作一样，使用苯二氮卓类药物进行治疗，随后给予抗癫痫药物。

目前建议对任何开放性骨折伴有颅内出血、脑脊液漏或严重污染或影响美观的严重畸形的患者进行手术修补。[9]Al-Haddad SA, Kirollos R. A 5-year study of the outcome of surgically treated depressed skull fractures. Ann R Coll Surg Engl. 2002;84:196-200.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503833/pdf/annrcse01637-0060.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/12092875?tool=bestpractice.com[53]Heary RF, Hunt CD, Krieger AJ, et al. Nonsurgical treatment of compound depressed skull fractures. J Trauma. 1993;35:441-447.http://www.ncbi.nlm.nih.gov/pubmed/8371305?tool=bestpractice.com[54]Marbacher S, Andres RH, Fathi AR, et al. Primary reconstruction of open depressed skull fractures with titanium mesh. J Craniofac Surg. 2008;19:490-495.http://www.ncbi.nlm.nih.gov/pubmed/18362730?tool=bestpractice.com[55]Bullock MR, Chesnut R, Ghajar J, et al; Surgical Management of Traumatic Brain Injury Author Group. Surgical management of depressed cranial fractures. Neurosurgery. 2006;58(3 suppl):S56-S60.http://www.ncbi.nlm.nih.gov/pubmed/16540744?tool=bestpractice.com治疗延迟会增加感染性并发症的风险。

手术修补应集中于失活组织的清创、任何手术性颅内病变的清除、硬膜闭合及颅骨成形术。替换骨折碎片对降低感染性并发症的发病率并无不利影响。[9]Al-Haddad SA, Kirollos R. A 5-year study of the outcome of surgically treated depressed skull fractures. Ann R Coll Surg Engl. 2002;84:196-200.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503833/pdf/annrcse01637-0060.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/12092875?tool=bestpractice.com[54]Marbacher S, Andres RH, Fathi AR, et al. Primary reconstruction of open depressed skull fractures with titanium mesh. J Craniofac Surg. 2008;19:490-495.http://www.ncbi.nlm.nih.gov/pubmed/18362730?tool=bestpractice.com[55]Bullock MR, Chesnut R, Ghajar J, et al; Surgical Management of Traumatic Brain Injury Author Group. Surgical management of depressed cranial fractures. Neurosurgery. 2006;58(3 suppl):S56-S60.http://www.ncbi.nlm.nih.gov/pubmed/16540744?tool=bestpractice.com

以前，大部分开放性颅骨骨折患者均采用一种两步法（包括初次清创术和抬高骨折碎片）以及二次颅骨成形术进行治疗。现在通常进行单步法操作。严重污染的开放性颅骨骨折应在 2-3 个月内进行 CT 扫描随访，以排除颅内感染。[3]Ersahin Y, Mutluer S, Mirzai H, et al. Pediatric depressed skull fractures: analysis of 530 cases. Childs Nerv Syst. 1996;12:323-331.http://www.ncbi.nlm.nih.gov/pubmed/8816297?tool=bestpractice.com[41]Donovan DJ. Simple depressed skull fracture causing sagittal sinus stenosis and increased intracranial pressure: case report and review of the literature. Surg Neurol. 2005;63:380-383.http://www.ncbi.nlm.nih.gov/pubmed/15808730?tool=bestpractice.com[55]Bullock MR, Chesnut R, Ghajar J, et al; Surgical Management of Traumatic Brain Injury Author Group. Surgical management of depressed cranial fractures. Neurosurgery. 2006;58(3 suppl):S56-S60.http://www.ncbi.nlm.nih.gov/pubmed/16540744?tool=bestpractice.com

如果有证据表明存在颅神经损伤（例如听力受损持续时间超过 3 个月、面神经麻痹）或持续性脑脊液漏，则需进行手术修补。[56]Yetiser S, Hidir Y, Gonul E. Facial nerve problems and hearing loss in patients with temporal bone fractures: demographic data. J Trauma. 2008;65:1314-1320.http://www.ncbi.nlm.nih.gov/pubmed/19077620?tool=bestpractice.com[57]Dalgic A, Okay HO, Gezici AR, et al. An effective and less invasive treatment of post-traumatic cerebrospinal fluid fistula: closed lumbar drainage system. Minim Invasive Neurosurg. 2008;51:154-157.http://www.ncbi.nlm.nih.gov/pubmed/18521786?tool=bestpractice.com这在颅底骨折中最常见。然而，几乎无证据表明面神经麻痹的手术治疗优于保守治疗。[58]Nash JJ, Friedland DR, Boorsma KJ, et al. Management and outcomes of facial paralysis from intratemporal blunt trauma: a systematic review. Laryngoscope. 2010;120:1397-1404.http://www.ncbi.nlm.nih.gov/pubmed/20564723?tool=bestpractice.com

腰部引流可用于治疗脑脊液漏。[59]Sherif C, Di leva A, Gibson D, et al. A management algorithm for cerebrospinal fluid leak associated with anterior skull base fractures: detailed clinical and radiological follow-up. Neurosurg Rev. 2012;35:227-237.http://www.ncbi.nlm.nih.gov/pubmed/21947554?tool=bestpractice.com

主要手术治疗是内窥镜鼻内修补术，该疗法的结果优于开颅手术，且并发症发病率较低。[46]Abuabara A. Cerebrospinal fluid rhinorrhoea: diagnosis and management. Med Oral Patol Oral Cir Bucal. 2007;12:E397-E400.http://www.medicinaoral.com/medoralfree01/v12i5/medoralv12i5p397.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/17767107?tool=bestpractice.com[57]Dalgic A, Okay HO, Gezici AR, et al. An effective and less invasive treatment of post-traumatic cerebrospinal fluid fistula: closed lumbar drainage system. Minim Invasive Neurosurg. 2008;51:154-157.http://www.ncbi.nlm.nih.gov/pubmed/18521786?tool=bestpractice.com[60]Yilmazlar S, Arslan E, Kocaeli H, et al. Cerebrospinal fluid leakage complicating skull base fractures: analysis of 81 cases. Neurosurg Rev. 2006;29:64-71.http://www.ncbi.nlm.nih.gov/pubmed/15937689?tool=bestpractice.com

最常见的鼻内手术并发症是嗅觉丧失。[46]Abuabara A. Cerebrospinal fluid rhinorrhoea: diagnosis and management. Med Oral Patol Oral Cir Bucal. 2007;12:E397-E400.http://www.medicinaoral.com/medoralfree01/v12i5/medoralv12i5p397.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/17767107?tool=bestpractice.com

一些数据支持对颅底骨折儿童使用肺炎球菌疫苗。[48]Demetriades D, Charalambides D, Lakhoo M, et al. Role of prophylactic antibiotics in open and basilar fractures of the skull: a randomized study. Injury. 1992;23:377-380.http://www.ncbi.nlm.nih.gov/pubmed/1428162?tool=bestpractice.com[50]Rehman L, Ghani E, Hussain A, et al. Infection in compound depressed fracture of the skull. J Coll Physicians Surg Pak. 2007;17:140-143.http://www.ncbi.nlm.nih.gov/pubmed/17374298?tool=bestpractice.com