新生兒及嬰兒顱骨凹陷骨折之非外科療法

Non surgical Treatment for Depressed Fractures of Skull in Newborns and Infants

嬰兒之顱骨凹陷骨折又稱乒乓球骨折，是一種特殊的頭骨骨折，乃是膜性頭骨向內凹陷所造成。關於此症之處理方法屢有不同意見，然而非外科療法是應該最先被考慮的。在過去15年間（1985~2000），我們曾經歷22例嬰兒之單純性顱骨凹陷骨折，其中男性14例，女性8例，年齡從新生兒至20個月不等。其中10例為新生兒，造成骨折之原因，包括產前（7例），產中（1例）及產後（2例）因素；而另12例較大嬰兒之骨折原因則有1例為先天因素，另11例為後天跌倒所致。凹陷的位置以頂部最多（11例），其次為顳部（7例）及額部（2例），有2例橫跨二個部位。全部凹陷以右側居多，佔14例。針對這種病例，我們的處理原則為：（1）若凹陷範圍不深（≦0.5公分），採取支持性的保守療法。（2）若凹陷深度超過0.5公分，則採用真空負壓吸引術治療。而真空吸引以金屬頭（2例）或連接塑膠罩杯（10例）來吸引，使用壓力自0.3至0.8（平均0.53）kg/cm2不等，吸引時間從20至90（平均46）秒不等。經過真空吸引後，除1例屬部分恢復外，其餘之顱骨凹陷均獲至完全恢復，局部頭皮紅腫也在一天內消失，並無任何不良反應。而採取保守療法之顱骨凹陷，也在一至六個月內得到部分或全部自然復原。所有病例經過二年至十五年之後續追蹤，均無神經學缺陷或癲癇之後遺症。本研究顯示非外科療法可為嬰兒單純性顱骨凹陷骨折之優先選擇，在不增加危險的情況下，對較大且深的凹陷骨折實施真空吸引術，亦不失為簡便且有效的處理方式。

Depressed skull fracture or ''Ping-pong ball'' fracture is a special form of skull fracture owing to inward buckling of the bony surface without loss of bony continuity. The methods of management are multifarious; however, nonsurgical modality has been suggested as the initial consideration. During the period 1985 to 2000, 22 infants with simple depressed skull fracture were evaluated. Males were 14 and females 8. The age ranged from newborn to 20 months. The locations were parietal (11 cases), temporal (7 cases), frontal (2 cases) area, with right side predominance (14 cases). For depressed area ≦0.5 cm in depth (n＝10), conservative method was given. For deeper (＞0.5cm) depressed fracture (n＝12), vacuum extraction was applied. A transparent plastic cup is attached to a vacuum extractor since the 3rd case. A negative pressure of 0.3-0.8 kg/cm2 (mean:0.53) was applied, with a duration of 20-90 seconds (mean:46). All except one had complete recovery after extraction, without major adverse effects. Most of the depressed fracture treated with conservative method got spontaneous recovery. Our study demonstrates that nonsurgical management has been the treatment of choice for simple depressed skull fracture in infants. Vacuum extraction is another option for larger and deeper depression, without additional risks, to get prompt recovery and relieve major anxiety of the family.