去骨瓣减压术后超早期三维钛网颅骨修补的临床研究

发布时间：2018-04-09 04:21

本文选题：颅脑损伤　切入点：颅骨修补　出处：《青岛大学》2017年硕士论文

【摘要】：目的:探讨重型颅脑损伤去骨瓣减压手术后颅骨缺损在超早期(4-6周内)行三维钛网颅骨修补的可行性和对患者长期预后的影响。方法:回顾性分析自2012年1月-2015年1月行颅脑损伤后颅骨缺损手术修补患者99例。根据去骨瓣减压术后行颅骨修补的间隔时间分为超早期组(4~6周)和常规组(3~6个月)两组。分析比较两组患者术中出血量、术中皮瓣分离时间、术后6月两组患者出现的相应并发症,并通过GOS评分、KPS评分和NIHSS评分比较两组患者行颅骨修补术后的生存质量。结果:超早期组患者术中出血量为(285.87±23.5)ml,皮瓣分离时间为(13.4±1.27)min。而常规组术中出血量多于超早期组,皮瓣分离时间长于超早期组,分别为(535.66±31.2)ml和(47.5±2.43)min。比较差异均有统计学意义(P0.05)。超早期组术中出血量的明显减少,降低了再次开颅手术的风险,减少了患者的经济负担,缩短了麻醉时间,术中的表现明显优于常规组。术后1月超早期组患者GOS评分、KPS评分和NIHSS评分依次为(2.8±0.7)、(53.3±7.6)和(6.2±0.1)。常规组患者GOS评分、KPS评分和NIHSS评分依次为(2.8±0.4)、(52.1±4.7)和(6.1±0.3)。各组数据比较,差异均无统计学意义(P0.05)。术后3月超早期组患者GOS评分、KPS评分和NIHSS评分依次为(3.9±0.3)、(64.5±7.1)和(4.1±0.2)。常规组患者GOS评分、KPS评分和NIHSS评分依次为(3.1±0.4)、(55.5±6.3)和(5.8±0.3)。各组数据比较,差异均有统计学意义(P0.05)。术后12月超早期组患者GOS评分、KPS评分和NIHSS评分依次为(4.2±0.1)、(75.3±6.4)和(2.5±0.9)。常规组患者GOS评分、KPS评分和NIHSS评分依次为(3.8±0.2)、(67.5±6.2)和(3.9±0.9)。各组数据比较,差异均有统计学意义(P0.05)。超早期颅骨修补组随访52例有0例发生硬膜下积液,常规组随访47例中有5例发生硬膜下积液,超早期组比率较常规组明显降低,比较差异有统计学意义(P0.05)。超早期组52例中共有5例出现硬膜下积液等并发症,常规组8例出现并发症,超早期组较常规组总体并发症发生率差异无统计学意义(P0.05)。结论:重度颅脑损伤去骨瓣减压术后患者在超早期(4~6周内)行颅骨修补在临床上是安全有效的,能够明显改善患者的预后和减少术后并发症的发生概率,并且能够减少术中出血,手术中皮瓣分离时间也有明显的缩短。
[Abstract]:Objective: to investigate the feasibility of three dimensional titanium mesh cranioplasty after craniotomy for severe craniocerebral injury and its effect on the long-term prognosis of patients with severe craniocerebral injury.Methods: from January 2012 to January 2015, 99 cases of cranial defect were repaired after craniocerebral injury.According to the interval time of cranioplasty after decompression of bone flap, the patients were divided into two groups: the super early group (4 weeks) and the routine group (3 ~ 6 months).The amount of blood loss during operation, the time of skin flap separation and the corresponding complications of the two groups were analyzed and compared. The quality of life after skull repair was compared by GOS score and NIHSS score.Results: the intraoperative blood loss was 285.87 卤23.5ml and the time of skin flap separation was 13.4 卤1.27min in the ultra-early group.However, the amount of intraoperative bleeding in the routine group was more than that in the ultra-early group, and the separation time of the flap was longer than that in the ultra-early group (535.66 卤31.2)ml and 47.5 卤2.43 min, respectively).The difference was statistically significant (P 0.05).The amount of intraoperative bleeding in the ultra-early group was significantly reduced, the risk of re-craniotomy was reduced, the economic burden of the patients was reduced, the anesthesia time was shortened, and the intraoperative performance was significantly better than that in the routine group.One month after operation, the GOS scores and NIHSS scores were 2.8 卤0.7 and 53.3 卤7.6, respectively.In the routine group, the GOS score and the NIHSS score were 2.8 卤0.4 and 52.1 卤4.7, respectively.There was no significant difference in the data of each group (P 0.05).Three months after operation, the GOS scores and the NIHSS scores were 3.9 卤0.3, 64.5 卤7.1, and 4.1 卤0.2, respectively.In the routine group, the GOS score and the NIHSS score were 3.1 卤0.4 and 55.5 卤6.3, respectively.The difference was statistically significant (P 0.05).12 months after operation, the GOS scores and the NIHSS scores of the patients in the super-early stage group were 4.2 卤0.1, 75.3 卤6.4) and 2.5 卤0.9, respectively.In the routine group, the GOS score and the NIHSS score were 3.8 卤0.2, 67.5 卤6.2, and 3.9 卤0.9, respectively.The difference was statistically significant (P 0.05).Subdural effusion was found in 0 of 52 cases in ultrearly cranioplasty group and in 5 out of 47 cases in routine group. The rate of subdural effusion in ultrearly group was significantly lower than that in routine group (P 0.05).There were 5 cases of complications such as subdural effusion in 52 cases of super early stage group and 8 cases of complications in routine group. There was no significant difference between the two groups in the incidence of complications (P 0.05).Conclusion: cranioplasty is safe and effective in patients with severe craniocerebral injury after bone flap decompression within 6 weeks. It can significantly improve the prognosis of patients and reduce the probability of postoperative complications.And it can reduce intraoperative bleeding and shorten the time of skin flap separation.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1

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