颅骨修补术后并发症及相关危险因素分析

发布时间：2018-05-31 19:11

本文选题：颅骨修补 + 并发症　；参考：《浙江大学》2015年硕士论文

【摘要】：背景：颅骨修补术不仅能恢复患者颅骨结构的完整性及外观的美观程度,还能减轻颅骨缺损给患者带来的心理负担,终止缺损造成的继发性脑损伤,促进神经功能的恢复。但颅骨修补术后并发症发生率较高。方法：选取2010年1月至2014年12月在浙江大学医学院附属第一医院就诊,经头颅CT或MRI诊断为颅骨缺损,住院行CT三维重建颅骨修补术的手术病人共计287例。通过统计患者的人口学特征、吸烟史、糖尿病及高血压病史、颅骨缺损病因、面积、两次手术时间间隔、术后并发症及二次手术情况,分析颅骨修补手术并发症情况及其相关危险因素。结果：颅骨修补术后并发症发生率为10.45%。其中术后出现头皮感染或颅内感染的患者最多,发生率为3.83%,其次为术后继发性癫痫(2.79%)及继发性脑积水(2.04%)。颅骨修补术后出现并发症的患者平均年龄为48.10±10.90岁,未出现并发症的患者平均年龄为43.65±13.57岁,两者具备显著性差异(p=0.046)。术后出现并发症患者颅骨缺损面积为114.93±40.43cm2,无并发症组颅骨缺损面积为92.94±42.08cm2。两者具备显著性差异(p=0.007)。患者首次手术行去骨瓣减压至二次颅骨修补手术时间间隔平均为4.42±3.30月,其中并发症组平均时间为7.23±8.35月,无并发症组平均时间为4.09±1.79月,两者具备显著性差异(p0.001)。颅骨缺损患者中因颅脑外伤行去骨瓣减压术最多,占81.18%,出现颅骨修补术后并发症者共计26例,发生率11.16%。高血压脑出血行去骨瓣减压患者共计22例(7.67%),颅骨修补术后并发症发生率为9.09%。动脉瘤、大面积脑梗死、颅脑肿瘤患者行颅骨修补术后并发症发生率分别为5.88%、11.11%、0。经检验不存在显著性差异。结论：本次研究中,颅骨修补术后并发症发生率较高,达到10.45%,包括继发性癫痫,脑积水,头皮或颅内感染,颅内血肿和死亡等,其中术后感染发生率最高,达到3.83%。并发症发生的危险因素包括高龄、大面积颅骨缺损、较长的手术时间间隔。
[Abstract]:Background: skull repair can not only restore the integrity of skull structure and aesthetic degree of appearance, but also reduce the psychological burden caused by skull defect, stop the secondary brain injury caused by the defect, and promote the recovery of nerve function. However, the incidence of complications after cranioplasty was higher. Methods: from January 2010 to December 2014, a total of 287 cases of cranial defect diagnosed by cranial CT or MRI in the first affiliated Hospital of Zhejiang University Medical College were selected. The demographic characteristics, smoking history, history of diabetes and hypertension, cause of skull defect, area of skull defect, interval between two operations, postoperative complications and secondary operation were analyzed. To analyze the complications of cranioplasty and related risk factors. Results: the incidence of complications after cranioplasty was 10.45. The incidence of postoperative scalp infection or intracranial infection was 3.83, followed by secondary epilepsy 2.79) and secondary hydrocephalus 2.04. The average age of the patients with complications after cranioplasty was 48.10 卤10.90 years old, and the average age of the patients without complications was 43.65 卤13.57 years old. There was a significant difference between the two groups. The area of skull defect was 114.93 卤40.43 cm ~ 2 in patients with postoperative complications, and 92.94 卤42.08 cm ~ 2 in non-complication group. There was significant difference between the two groups. The average time interval between the first operation and the second cranioplasty was 4.42 卤3.30 months, the average time of complication group was 7.23 卤8.35 months, and that of non-complication group was 4.09 卤1.79 months. There was significant difference between the two groups (P 0.001). Among the patients with cranial bone defect, decompression of craniocerebral trauma was the most, accounting for 81.18%. 26 cases had complications after cranioplasty, the incidence rate was 11.16%. A total of 22 patients with hypertensive intracerebral hemorrhage underwent decompression of bone flap. The incidence of complications after cranioplasty was 9.09. The incidence of postoperative complications in patients with aneurysm, large area cerebral infarction and craniocerebral tumor were 5.88 and 11.11 respectively. There was no significant difference by test. Conclusion: in this study, the incidence of complications after cranioplasty was 10.45, including secondary epilepsy, hydrocephalus, scalp or intracranial infection, intracranial hematoma and death, among which the incidence of postoperative infection was the highest (3.83%). Risk factors for complications include old age, large skull defects, and long operative intervals.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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