- 期刊
顳骨骨折：220例分析
Temporal Bone Fractures: Analysis of 220 Cases
摘要
背景：在急診常見的頭部外傷病人，發生顳骨骨折的比率並不低。本文嘗試就近來急診顳骨骨折的病患，探討其發生原因、症狀及預後的情形，以作為日後診療的參考。 方法：收集1993年1月至1996年12月四年間，因頭外傷至成大醫院急診，經診斷為顳骨骨折者，共220人（236耳）。分析其發生原因、理學檢查發現、聽力檢查和放射學檢查結果及顏面神經麻痺和腦脊髓液耳漏的預後情形。 結果：發生原因以車禍意外最多（81%）。理學檢查的發現包鼓室積血、耳道流血、外耳道撕裂傷、鼓膜穿孔、顏面神經麻痺及腦脊髓液耳漏。發生腦脊髓液耳漏的有5名病患（2%），其皆採保守治療治並給與預防性抗生素。除1名因嚴重腦挫傷死亡外，其餘4名腦脊髓耳漏都完全恢復，且無併發症發生。發生顏面神經麻痺的有31名病患（31%），追蹤結果，若為遲發性且為不完全顏面神經麻痺者預後者較佳，而即發性或完全顏面神經麻痺者則預後較差。聽力障礙方面，單項以傳導性聽力障礙為多，但約近半數具感音性聽力障礙成分（即包括音性及混合性聽力障礙者）。 結論：腦脊髓液耳漏一般可由保守治療法治癒。顏面神經麻痺若為遲發性且為不完全性麻痺者預後較佳。若為即發性或完全性麻痺者則預後差，需接受電生理檢查，以決定是否必要接受手術治療。至於聽力障礙方面，內耳或聽神經受損致感音性聽力障礙成分（即包括感音性及混合性聽力障礙者）佔了多數，表示顳骨骨折致內耳或聽神受損之情形不容忽視。
並列摘要
Background: Temproal bone fractures are not uncommonly encountered in the patients with head injuries at the emergent service. Methods: A retrospective study of 220 patients with temporal bone fratures over a 4-year period at National Cheng Kung University Hospital was done. The study was to examine the incidence of complications resulting from temporal bone fractures and to analyze the outcomes of cerebrospinal fluid (CSF) otorrhea and facial paralysis. Results: The most common cause of a temporal bone fracture was traffic accident. Pertinent physical findings were hemotympanum, bloody otorrhea, tympanic membrane rupture, and CSF otorrhea. CSF otorrhea was found in 5 patients (2%). Except that one patient died shortly after arrival due to severe head injury, the CSF otorrhea recovered spontaneously without complication in others. Facial paralysis was found in 31 patients (13%). Those with delayed-onset and incomplete facial paralysis had good recovery. However, recovery in those with immediate-onset or complete facial paralysis was poor. Hearing test showed prevalent sensorineural damage in those patients with sensorineural and mixed type hearing loss. Conclusions: All cases will CSF otorrhea recovered with conservative treatment. Recovery in those with immediate-onset or complete facial apralysis was poor so that early surgical intervention may be indicated. Furthermore, trauma of the inner ear and auditory nerve resulted in hearing impairment is not negligible in patients with temporal bone fracture.