颅骨缺损修补手术时机与方法优化及效果评价

发布时间：2018-11-23 18:10

【摘要】：为了探索颅骨缺损手术时机与方法的优化措施并对效果进行评价,我们结合临床实践,引进先进手术技术,标准化手术术式,规范适应症的选择标准,开展颅骨缺损的早期修补。临床效果分析表明手术难度、手术风险大大降低,患者住院天数缩短,总费用下降,并有助于神经功能的早期恢复,效果明显。笔者从巴彦淖尔市、鄂尔多斯市的四所医院选取了 83例颅骨缺损的患者,依照纳入的标准按时间将修补手术患者分成三组。所有纳入标准的患者,除常规检验、放射、心电图等准备外,术前要进行头部CT的薄层扫描,了解颅内情况,并在缺损区域进行三维重建。手术麻醉的方法都选用全麻下气管插管麻醉。手术方式是常规的手术方法。分析结果表明所有患者都手术顺利,平安出院,而且都获得了随访,平均随访时间为6个月。颅骨缺损患者修补术后,颅骨缺损综合征均消失,患者原有的神经功能障碍也都有不同程度的好转。患者术后神经功能的恢复情况统计结果可以看出早期组的恢复率最高,可以达到83.3%,对比明显,常规时间组的神经功能恢复率最差仅为62.5%。早期组内对比得出并非手术时间越靠前神经功能恢复越好,而是在首次手术后的第三周及第四周行颅骨修补术,神经功能恢复率最高。通过对患者术后的并发症进行统计比对分析,早期手术组与常规时间手术组、中期手术组与常规时间手术组的比较均具有统计学意义(p0.05)。另外对患者颅骨修补术后2周随访比对后发现,早期手术组、中期手术组与常规时间手术组的患者在GCS评分及GOS的评分比较分析无统计学意义(p0.05),而在修补术后6个月的随访中,患者在这俩种评分中均具有统计学意义(均p0.05),但早期手术组及中期手术组之间比较仍然无统计学意义(p0.05)。这也就表明笔者在颅骨缺损修补手术时机和手术方法的选择上已经取得了理想的结果。综上所述,早期的颅骨缺损修补手术可以使所有患者的颅骨缺损综合征消失,而且原有的神经功能的障碍问题也在修补手术后有不同程度的好转;其次在患者精神心理上的康复也能起到积极的作用,可以使患者早日融入社会,促进患者身心的早日康复。另外早期行颅骨缺损的修补手术,在缩短患者病程、减少治疗费用方面都有较好的效果,的确具有推广的价值。
[Abstract]:In order to explore the optimal operation time and method for skull defect and evaluate the effect, we introduced advanced surgical techniques, standardized surgical procedures, and standardized the selection criteria of indications combined with clinical practice. Early repair of skull defect was carried out. The clinical effect analysis showed that the difficulty of operation, the risk of operation were greatly reduced, the days of hospitalization were shortened, the total cost was decreased, and it was helpful to the early recovery of nerve function, and the effect was obvious. 83 patients with skull defects were selected from four hospitals in Bayannur and Ordos, and divided into three groups according to the inclusive criteria. In addition to routine examination, radiography and electrocardiogram, all patients who were included in the standard should be scanned by thin layer of head CT before operation to understand the intracranial condition, and to perform 3D reconstruction in the defect area. All the methods of operation anesthesia were anesthetized by tracheal intubation under general anesthesia. Operation is a routine procedure. The results showed that all patients were successfully operated, discharged safely and were followed up for an average of 6 months. The cranial defect syndrome disappeared after the repair of skull defect, and the original neurological dysfunction was improved to some extent. The recovery rate of nerve function in the early group was the highest (83.3%). The recovery rate of nerve function in the routine time group was only 62.5%. The results showed that the recovery rate of nerve function was the highest in the third week and four weeks after the first operation. Through the statistical comparison and analysis of postoperative complications, the comparison between the early operation group and the routine operation group, the middle operation group and the routine time operation group was statistically significant (p0.05). In addition, there was no significant difference in GCS score and GOS score between early operation group, middle operation group and routine operation group after 2 weeks follow-up (p0.05). In the follow-up of 6 months after repair, there was significant difference between the two groups (p0.05), but there was no significant difference between the early operation group and the intermediate operation group (p0.05). This indicates that the author has achieved satisfactory results in the choice of time and method of skull defect repair. To sum up, the early cranial defect repair surgery can make all patients' skull defect syndrome disappear, and the original neurological dysfunction can be improved in varying degrees after the repair operation. Secondly, the psycho-psychological rehabilitation can also play a positive role in the early integration of patients into society, and promote the early recovery of patients. In addition, the early repair of skull defect has a good effect in shortening the course of disease and reducing the cost of treatment.
【学位授予单位】：内蒙古大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1

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