早期颅骨修补并脑室腹腔分流治疗颅脑损伤的效果及可行性研究
发布时间：2019-03-25 11:41
【摘要】：目的：探讨早期颅骨修补并脑室腹腔分流治疗应用于颅脑损伤患者中的临床疗效,并评价该手术方案应用于脑外伤治疗中的安全性以及可行性,同时分析影响颅骨修补并发症的相关因素。方法：选择2008年1月～2012年1月在我院神经外科住院治疗的72例需行脑室腹腔分流术的颅骨缺损患者为研究对象,按照颅骨修补手术时间分为A组和B组。其中A组采取脑室腹腔分流术合并早期(2个月内)颅骨修补术治疗,共40例患者；B组采取先行脑室腹腔分流术,在2个月后再行颅骨修补术,共32例患者。对两组患者进行为期6月到1年的追踪随访,采用格拉斯哥昏迷(GCS)评分系统评价两组患者术后昏迷程度；利用Barthel指数评价两组患者日常生活能力；利用Fugl-Meyer法评价两组患者肢体运动功能和神经缺损程度,记录数据并做好对比。另外,再观察两组患者并发症情况,并分析影响并发症的相关因素。结果：(1)A组行早期颅骨修补术能轻松游离皮瓣,平均手术时间为95.34±4.73min,游离皮瓣平均时间为15.4士1.25mmin,平均术中出血量为336.68±24.73m1；B组行晚期颅骨修补术,平均手术时间为133.68±5.14min,游离皮瓣平均时间为40.68±3.12min,平均术中出血量为574.32±26.59m1,两组患者的上述指标之间的差异均存在明显统计学差异(P0.01)。(2)A组患者术后恢复良好36例(90.00%)、中度残疾4例(10.00%)、重度残疾0例(0.00%)；B组术后恢复良好22例(68.75%)、中度残疾5例(15.63%)、重度残疾5例(15.63%),两组手术中无死亡病例,两组恢复情况比较差异不具有统计学意义(P0.05)。(3)术前,两组GCS评分差异不具有统计学意义(P0.05),术后及随访期间A组GCS评分明显优于B组(P0.05)；两组患者术后ADL、肢体运动功能和神经功能和术前相比都有一定程度恢复(P0.05),但是A组各项指标改善情况明显优于B组(P0.05)。(4)B组有1例并发分流管堵塞、有3例出现感染、皮下积液2例,颅内血肿1例、头皮坏死1例、脑脊液漏2例、并发症发生率为31.25%；而A组术中无分流管堵塞,2例出现感染,1例皮下积液,未发生脑脊液漏、头皮坏死、修补材料外露、颅骨骨瓣吸收、修补材料塌陷移位等,并发症发生率为7.50%,两组之间差异具有统计学意义(X2=6.78,P0.05)。(5)患者的年龄和缺损程度均为导致并发症的主要因素,老年患者并发症发生率明显高于青年患者(P0.05),损伤面积大的患者并发症发生率明显高于损伤面积小的患者(P0.05)。结论：对于颅脑损伤患者,行早期颅骨修补并脑室腹腔分流手术,不仅能满足患者外形美观的要求,同时还能有效地提高其生活质量,并能有效地促进脑组织局部血流量的恢复,预防缺损部位脑组织再度损伤,进而恢复和改善患者的神经功能。该手术方案疗效满意,并发症发生率低,主要的影响因素为年龄和缺损面积大小。所以,开展早期颅骨修补术联合脑室腹腔分流术治疗颅脑外伤是一种安全有效的治疗方式,值得在临床上进一步推广和应用。
[Abstract]:Objective: To study the clinical effect of early skull repair and intraventricular shunt treatment in patients with head injury, and to evaluate the safety and feasibility of the operation in the treatment of head injury. Methods: From January 2008 to January 2012,72 cases of skull defect with ventriculoperitoneal shunt were divided into group A and group B according to the time of skull repair. In group A, a total of 40 patients were treated by intraventricular shunt and early (2-month) skull repair. Two groups of patients were followed up for a period of 6 months to 1 year. The Glasgow Coma (GCS) scoring system was used to evaluate the degree of coma of the two groups, and the daily life of the two groups was evaluated by the Barthel index. The function of limb movement and the degree of nerve defect in the two groups were evaluated by the Fugl-Meyer method. Record the data and make a comparison. In addition, the complications of the two groups were observed and the related factors of the complications were analyzed. Results: (1) The average operation time was 95.34-4.73min, the average operation time was 95.34-4.73min, the mean time of free-skin flap was 15.4-1.25 mmin, the average operation time was 336.68-24.73ml, and the average operation time was 133.68-5.14min. The mean time of free flap was 40.68-3.12 min, the amount of intraoperative blood loss was 574.32-26.59 ml, and there was a significant difference in the difference between the two groups (P0.01). (2) There were 36 cases (90.00%) in group A,4 (10.00%) with moderate disability,0 (0.00%) with severe disability,22 (68.75%) in group B,5 (15.63%) with moderate disability and 5 (15.63%) with severe disability. The difference between the two groups was not statistically significant (P0.05). (3) The GCS scores of the two groups were not statistically significant before and after operation (P0.05). The GCS scores of group A in group A after operation and follow-up were significantly better than that of group B (P0.05). However, that improvement of the index in group A was better than that of group B (P0.05). (4) There were 1 case complicated with shunt in group B. There were 3 cases of infection,2 cases of subcutaneous effusion,1 case of intracranial hematoma,1 case of scalp necrosis,2 cases of cerebrospinal fluid leakage, and 31.25% of complication rate. The incidence of complications was 7.50%, and the difference between the two groups was statistically significant (X2 = 6.78, P0.05). (5) The age and defect of the patients were the main factors leading to the complications. The complication rate of the old patients was significantly higher than that of the young (P0.05). The complication rate of the patients with large injury area was significantly higher than that of the patients with small injury area (P0.05). Conclusion: For the patients with head injury, the early-stage skull repair and the intraventricular shunting operation can not only meet the requirements of the appearance of the patients, but also can effectively improve the quality of life of the patients, and can effectively promote the recovery of the local blood flow in the brain tissue. The brain tissue of the defect part is prevented from being damaged again, and the neurological function of the patient is recovered and improved. The result of the operation is satisfactory, the complication rate is low, and the main influencing factors are age and defect area size. Therefore, it is a safe and effective way for the treatment of head injury with the combination of the early skull repair and the intraventricular shunt. It is worth further promotion and application in clinic.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R651.15
本文编号：2446938
[Abstract]:Objective: To study the clinical effect of early skull repair and intraventricular shunt treatment in patients with head injury, and to evaluate the safety and feasibility of the operation in the treatment of head injury. Methods: From January 2008 to January 2012,72 cases of skull defect with ventriculoperitoneal shunt were divided into group A and group B according to the time of skull repair. In group A, a total of 40 patients were treated by intraventricular shunt and early (2-month) skull repair. Two groups of patients were followed up for a period of 6 months to 1 year. The Glasgow Coma (GCS) scoring system was used to evaluate the degree of coma of the two groups, and the daily life of the two groups was evaluated by the Barthel index. The function of limb movement and the degree of nerve defect in the two groups were evaluated by the Fugl-Meyer method. Record the data and make a comparison. In addition, the complications of the two groups were observed and the related factors of the complications were analyzed. Results: (1) The average operation time was 95.34-4.73min, the average operation time was 95.34-4.73min, the mean time of free-skin flap was 15.4-1.25 mmin, the average operation time was 336.68-24.73ml, and the average operation time was 133.68-5.14min. The mean time of free flap was 40.68-3.12 min, the amount of intraoperative blood loss was 574.32-26.59 ml, and there was a significant difference in the difference between the two groups (P0.01). (2) There were 36 cases (90.00%) in group A,4 (10.00%) with moderate disability,0 (0.00%) with severe disability,22 (68.75%) in group B,5 (15.63%) with moderate disability and 5 (15.63%) with severe disability. The difference between the two groups was not statistically significant (P0.05). (3) The GCS scores of the two groups were not statistically significant before and after operation (P0.05). The GCS scores of group A in group A after operation and follow-up were significantly better than that of group B (P0.05). However, that improvement of the index in group A was better than that of group B (P0.05). (4) There were 1 case complicated with shunt in group B. There were 3 cases of infection,2 cases of subcutaneous effusion,1 case of intracranial hematoma,1 case of scalp necrosis,2 cases of cerebrospinal fluid leakage, and 31.25% of complication rate. The incidence of complications was 7.50%, and the difference between the two groups was statistically significant (X2 = 6.78, P0.05). (5) The age and defect of the patients were the main factors leading to the complications. The complication rate of the old patients was significantly higher than that of the young (P0.05). The complication rate of the patients with large injury area was significantly higher than that of the patients with small injury area (P0.05). Conclusion: For the patients with head injury, the early-stage skull repair and the intraventricular shunting operation can not only meet the requirements of the appearance of the patients, but also can effectively improve the quality of life of the patients, and can effectively promote the recovery of the local blood flow in the brain tissue. The brain tissue of the defect part is prevented from being damaged again, and the neurological function of the patient is recovered and improved. The result of the operation is satisfactory, the complication rate is low, and the main influencing factors are age and defect area size. Therefore, it is a safe and effective way for the treatment of head injury with the combination of the early skull repair and the intraventricular shunt. It is worth further promotion and application in clinic.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R651.15
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