【摘要】：研究背景： 顱腦外傷是當(dāng)前神經(jīng)外科常見病及多發(fā)病之一,其中顱腦外傷后腦積水是顱腦外傷后病人導(dǎo)致病人致殘率及致死率增高的重要原因之一。若不能得到及時有效地治療,常會因顱內(nèi)壓力增高導(dǎo)致嚴(yán)重后果。腦積水定義為腦脊液生成及吸收失衡導(dǎo)致的腦室系統(tǒng)擴(kuò)大,目前腦積水的分類方法較多,臨床上最常用的分類方法為交通性及非交通性腦積水,主要依賴于腦脊液循環(huán)通路受阻的部位,若阻塞的部位是在蛛網(wǎng)膜顆粒以上,則阻塞部位以上的腦室擴(kuò)大,稱為非交通性腦積水,若阻塞部位在蛛網(wǎng)膜顆粒水平則為交通性腦積水,表現(xiàn)為所有腦室及蛛網(wǎng)膜下腔均擴(kuò)大,該種分類方法有助于臨床治療方案的選擇。腦積水形成的原因包括出血、腦膜炎、顱腦損傷等,因顱腦損傷受傷機(jī)制多樣,因此顱腦外傷后腦積水的風(fēng)險(xiǎn)因素尚未全面系統(tǒng)地研究。其中重型顱腦損傷后行外傷性大骨瓣減壓術(shù)已成為救治重型顱腦損傷的首選治療方案,但隨該手術(shù)方案在臨床上的廣泛應(yīng)用,臨床上發(fā)現(xiàn)術(shù)后腦積水發(fā)生成為治療的難題,因此行術(shù)中及術(shù)后各環(huán)節(jié)尋找導(dǎo)致腦積水形成的危險(xiǎn)因素。 目的： 本研究旨在探討顱腦損傷后及去骨瓣減壓術(shù)后導(dǎo)致腦積水形成的相關(guān)風(fēng)險(xiǎn)因素。揭示不同程度的顱腦損傷與腦積水形成的相關(guān)性及去骨瓣減壓手術(shù)因素與腦積水形成之間的關(guān)系。 方法： 以2008年4月至2013年4月份收治的顱腦損傷的760例病人,跟蹤隨訪其中發(fā)生腦積水的有126例,根據(jù)入院時患者的性別、是否昏迷、GCS評分,以及影像學(xué)資料中有無腦挫裂傷、蛛網(wǎng)膜下腔出血、硬膜外血腫、顱骨骨折、開放性顱腦損傷和腦脊液漏等因素,分別探究其與腦積水形成之間的關(guān)系。另外,在760例病人中有124例病人曾行去骨瓣減壓術(shù),通過比較分析了是否行早期手術(shù)、是否行雙側(cè)去骨瓣減壓術(shù)、骨窗的面積及高度、是否早期行顱骨缺損修補(bǔ)術(shù)等因素與腦積水的發(fā)生有無相關(guān)性。 結(jié)果： 根據(jù)統(tǒng)計(jì)學(xué)分析得出昏迷程度及GCS評分、蛛網(wǎng)膜下腔出血、腦室出血及硬膜下出血等因素的差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。通過對手術(shù)參數(shù)比較分析得出雙側(cè)去骨瓣減壓術(shù)、骨窗高度及面積、二次手術(shù)、早期顱骨缺損修補(bǔ)等因素的差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。 結(jié)論： 傷后昏迷程度,蛛網(wǎng)膜下腔出血,腦室出血,硬膜下出血,雙側(cè)去骨瓣減壓術(shù),骨窗的高度及面積,未能及時顱骨修補(bǔ)等因素為外傷后腦積水的風(fēng)險(xiǎn)因素。
[Abstract]:Background: craniocerebral trauma is one of the most common diseases in neurosurgery. Hydrocephalus after craniocerebral injury is one of the important reasons for the increase of disability rate and fatality rate in patients with craniocerebral trauma. If you can not get timely and effective treatment, often due to increased intracranial pressure leading to serious consequences. Hydrocephalus is defined as the enlargement of the ventricular system caused by the imbalance of cerebrospinal fluid production and absorption. There are many classification methods for hydrocephalus at present. The most commonly used classification methods in clinic are traffic hydrocephalus and non-communicating hydrocephalus. If the blocked area is above the arachnoid granule, the ventricle above the obstructed area is enlarged, which is called non-communicating hydrocephalus. If the location of obstruction is communicating hydrocephalus at the level of arachnoid granule, all ventricle and subarachnoid space are enlarged. This classification method is helpful to the choice of clinical treatment. The causes of hydrocephalus include hemorrhage meningitis craniocerebral injury and so on. Traumatic large bone flap decompression after severe craniocerebral injury has become the first choice in the treatment of severe craniocerebral injury. However, with the wide application of the surgical plan in clinical practice, the occurrence of hydrocephalus has become a difficult problem in the treatment of severe craniocerebral injury. Therefore, intraoperative and postoperative procedures were performed to find the risk factors leading to hydrocephalus. Objective: to investigate the risk factors of hydrocephalus after craniocerebral injury and bone flap decompression. To reveal the correlation between craniocerebral injury and hydrocephalus formation, and the relationship between the factors of decompression of bone flap and hydrocephalus formation. Methods: a total of 760 patients with craniocerebral injury admitted from April 2008 to April 2013 were followed up. 126 patients with hydrocephalus were followed up. According to the gender of the patients at the time of admission, whether they were unconscious or not, the GCS score was evaluated. The relationship between cerebral contusion and laceration, subarachnoid hemorrhage, epidural hematoma, skull fracture, open craniocerebral injury and cerebrospinal fluid leakage was investigated. In addition, 124 out of 760 patients had undergone decompression of bone flap. By comparison, we analyzed whether early operation, bilateral decompression of bone flap, area and height of bone window were performed. Whether early cranial defect repair is associated with hydrocephalus. Results: according to statistical analysis, there were significant differences in coma degree and GCS score, subarachnoid hemorrhage, intraventricular hemorrhage and subdural hemorrhage (p0.05). By comparing and analyzing the operation parameters, we found that there were significant differences in bilateral bone flap decompression, bone window height and area, secondary operation, early cranial defect repair and so on (p0.05). Conclusion: the risk factors of post-traumatic hydrocephalus were coma degree, subarachnoid hemorrhage, intraventricular hemorrhage, subdural hemorrhage, bilateral decompression of bone flap, height and area of bone window and failure to repair skull in time.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R651.15

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