本文選題：顱腦損傷　切入點(diǎn)：顱骨修補(bǔ)　出處：《青島大學(xué)》2017年碩士論文

【摘要】：目的:探討重型顱腦損傷去骨瓣減壓手術(shù)后顱骨缺損在超早期(4-6周內(nèi))行三維鈦網(wǎng)顱骨修補(bǔ)的可行性和對(duì)患者長(zhǎng)期預(yù)后的影響。方法:回顧性分析自2012年1月-2015年1月行顱腦損傷后顱骨缺損手術(shù)修補(bǔ)患者99例。根據(jù)去骨瓣減壓術(shù)后行顱骨修補(bǔ)的間隔時(shí)間分為超早期組(4~6周)和常規(guī)組(3~6個(gè)月)兩組。分析比較兩組患者術(shù)中出血量、術(shù)中皮瓣分離時(shí)間、術(shù)后6月兩組患者出現(xiàn)的相應(yīng)并發(fā)癥,并通過(guò)GOS評(píng)分、KPS評(píng)分和NIHSS評(píng)分比較兩組患者行顱骨修補(bǔ)術(shù)后的生存質(zhì)量。結(jié)果:超早期組患者術(shù)中出血量為(285.87±23.5)ml,皮瓣分離時(shí)間為(13.4±1.27)min。而常規(guī)組術(shù)中出血量多于超早期組,皮瓣分離時(shí)間長(zhǎng)于超早期組,分別為(535.66±31.2)ml和(47.5±2.43)min。比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。超早期組術(shù)中出血量的明顯減少,降低了再次開(kāi)顱手術(shù)的風(fēng)險(xiǎn),減少了患者的經(jīng)濟(jì)負(fù)擔(dān),縮短了麻醉時(shí)間,術(shù)中的表現(xiàn)明顯優(yōu)于常規(guī)組。術(shù)后1月超早期組患者GOS評(píng)分、KPS評(píng)分和NIHSS評(píng)分依次為(2.8±0.7)、(53.3±7.6)和(6.2±0.1)。常規(guī)組患者GOS評(píng)分、KPS評(píng)分和NIHSS評(píng)分依次為(2.8±0.4)、(52.1±4.7)和(6.1±0.3)。各組數(shù)據(jù)比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后3月超早期組患者GOS評(píng)分、KPS評(píng)分和NIHSS評(píng)分依次為(3.9±0.3)、(64.5±7.1)和(4.1±0.2)。常規(guī)組患者GOS評(píng)分、KPS評(píng)分和NIHSS評(píng)分依次為(3.1±0.4)、(55.5±6.3)和(5.8±0.3)。各組數(shù)據(jù)比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后12月超早期組患者GOS評(píng)分、KPS評(píng)分和NIHSS評(píng)分依次為(4.2±0.1)、(75.3±6.4)和(2.5±0.9)。常規(guī)組患者GOS評(píng)分、KPS評(píng)分和NIHSS評(píng)分依次為(3.8±0.2)、(67.5±6.2)和(3.9±0.9)。各組數(shù)據(jù)比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。超早期顱骨修補(bǔ)組隨訪(fǎng)52例有0例發(fā)生硬膜下積液,常規(guī)組隨訪(fǎng)47例中有5例發(fā)生硬膜下積液,超早期組比率較常規(guī)組明顯降低,比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。超早期組52例中共有5例出現(xiàn)硬膜下積液等并發(fā)癥,常規(guī)組8例出現(xiàn)并發(fā)癥,超早期組較常規(guī)組總體并發(fā)癥發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:重度顱腦損傷去骨瓣減壓術(shù)后患者在超早期(4~6周內(nèi))行顱骨修補(bǔ)在臨床上是安全有效的,能夠明顯改善患者的預(yù)后和減少術(shù)后并發(fā)癥的發(fā)生概率,并且能夠減少術(shù)中出血,手術(shù)中皮瓣分離時(shí)間也有明顯的縮短。
[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 鹵23.5ml and the time of skin flap separation was 13.4 鹵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 鹵31.2)ml and 47.5 鹵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 鹵0.7 and 53.3 鹵7.6, respectively.In the routine group, the GOS score and the NIHSS score were 2.8 鹵0.4 and 52.1 鹵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 鹵0.3, 64.5 鹵7.1, and 4.1 鹵0.2, respectively.In the routine group, the GOS score and the NIHSS score were 3.1 鹵0.4 and 55.5 鹵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 鹵0.1, 75.3 鹵6.4) and 2.5 鹵0.9, respectively.In the routine group, the GOS score and the NIHSS score were 3.8 鹵0.2, 67.5 鹵6.2, and 3.9 鹵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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R651.1

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