NHÂN TRƯỜNG HỢP LÚN SỌ KÍN ĐƯỢC PHẪU THUẬT TẠI BV SẢN NHI AN GIANG

DANH MỤC CHIA SẼ
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CA LÂM SÀNG

  Ngày 11-6-2020, Bé L.P.L, 41 tháng tuổi, vào viện với đỉnh đầu sưng to, quấy khóc nhiều sau té từ lầu 1 xuống nền nhà, được người thân đưa vào Bệnh viện Sản Nhi An Giang cấp cứu. Qua khám lâm sàng và kết hợp hình ảnh CT-scan sọ não (hình 1), bé được chẩn đoán lỏm sọ kín đính trái (T), và được các bác sĩ khoa Ngoại Nhi quyết định phẫu thuật để nâng xương sọ bị lún.

LUNNAO

Hình 1. Hình ảnh CT-scan sọ não của bé L.P.L.

  Kết quả sau 4 ngày điều trị (hình 2): Bé tỉnh táo hoàn toàn, tri giác tốt,không yếu liệt chi, vết mổ khô, hình dạng hộp sọ được phục hồi bình thường.

LUNNAO1

Hình 2. Kết quả sau mổ hình dạng hộp sọ tròn đều, vết mổ lành tốt.

BÀN LUẬN

  Lún sọ hay lỏm sọ là tình trạng chấn thương sọ não làm xương sọ bị lún vào trong hộp sọ do tác động ngoại lực, thường được chia làm 4 dạng: lún sọ hở, lún sọ kín, lún sọ pingpong, và vỡ sọ tiến triển.

  1. Lún sọ hở: vị trí xương sọ lún thông thương với môi trường ngoài qua vết thương da đầu. Chỉ định phẫu thuật khi:lún sọ hơn một bản sọ, nghi ngờ có rách màng cứng, liên quan xoang trán, có máu tụ nội sọ hay nhiễm trùng vết thương, biến dạng nặng gây mất thẩm mỹ kéo dài.

  2. Lún sọ kín: vị trí xương sọ lún không thông thương với môi trường ngoài. Chỉ định phẫu thuật khi: có dấu thần kinh định vị, rách màng cứng, khítụ trong sọ, lún sâu>lcm, tổn thương xoang trán mất thẩm mỹ.

  3. Lún sọ Ping Pong: ít khi cần can thiệp phẫu thuật vì có thể tự điều chỉnh khi lớn. Chỉ định phẫu thuật khi: có các mảnh xương trong nhu mô, có dấu hiệu thần kinh khu trú, có triệu chứng tăng áp lực nội sọ, có dấu hiệu của tụ dịch não tủy dưới cân Galea, gặp khó khăn trong việc theo dõi lâu dài.

  4. Vỡ sọ tiến triển: thường xảy ra ở trẻ < 3 tuổi(2/3 trường hợp ở trẻ< 1 tuổi). Hầu hết xảy ra trong vòng 2 tháng sau chấn thương. Vỡsọ kèm với rách màng cứng, sau đó sự phát triển của não làm đường nứt sọ và vết rách màng cứng rộng dần, làm não thoát vị qua khe nứt đó và bị tổn thương. Vỡsọ tiến triển cần can thiệp phẫu thuật và theo dõi lâu dài. Tái khám mỗi tháng trong 3 tháng đầu, sau đó mỗi 6 tháng cho đến 3 tuổi.

  Người bệnh lún sọ có rối loạn tri giác do nguyên nhân sọ não như: máu tụ dưới màng cứng, ngoài màng cứng, hoặc nhiễm khuẩn do rách màng cứng đều có chỉ định phẫu thuật. Sau khi nâng và lấy các mãnh sọ vỡ. Nếu không có bằng chứng vết thương nhiễm trùng nên đặt lại mãnh xương sọ đã lấy.

Các nguyên nhân gây lún sọ thường gặp như:

  + Tai nạn giao thông.

  + Tai nạn sinh hoạt: té ngã từ trên cao xuống đất, té cầu thang và các loại té ngã cơ chế nặng khác có va đập vùng đầu.

  + Bị bạo hành, bị đánh vào đầu.

  + Tai nạn thể thao, tai nạn do thảm họa, …

  + Đưa võng mạnh đầu trẻ bị va đập.

  + Chơi đùa, bế trẻ con tung cao rồi bị trượt tay, hoặc chơi cửi ngựa, xích đu…

  Trẻ em là lứa tuổi hiếu động, thích nô đùa chạy nhảy, dễ bị vấp ngã, ít kinh nghiệm khi tham gia giao thông. Vì vậy, các bậc phụ hynh cần quan tâm, chăm sóc, theo dõi các bé hết sức cẩn thận, phòng tránh các nguy cơ chấn thương cho bé, không nên để các trẻ nhỏ ở một mình, không cho trẻ chơi đùa gần những nơi nguy hiểm, đội mũ bảo hiểm an toàn cho bé khi tham gia giao thông.

TÀI LIỆU THAM KHẢO

1. Bệnh viện Nhi đồng Thành phố (2018), Phác đồ điều trị ngoại khoa chấn thương sọ não trẻ em, https://bvndtp.org.vn/phac-do-dieu-tri-ngoai-khoa-chan-thuong-so-nao-tre-em/.

2.Kiều Đình Hùng (2013), Phẫu thuật thần kinh: Kỹ thuật mổ cấp cứu sọ não, Nhà xuất bản Y học.

3. Mark S. Greenberg (2016),“Head Trauma”, Handbook of Neurosurgery 8th Ed, Thieme, p. 824 – 929.

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