本文選題：顱骨修補 + 并發(fā)癥��； 參考：《浙江大學》2015年碩士論文

【摘要】：背景：顱骨修補術(shù)不僅能恢復患者顱骨結(jié)構(gòu)的完整性及外觀的美觀程度,還能減輕顱骨缺損給患者帶來的心理負擔,終止缺損造成的繼發(fā)性腦損傷,促進神經(jīng)功能的恢復。但顱骨修補術(shù)后并發(fā)癥發(fā)生率較高。 方法：選取2010年1月至2014年12月在浙江大學醫(yī)學院附屬第一醫(yī)院就診,經(jīng)頭顱CT或MRI診斷為顱骨缺損,住院行CT三維重建顱骨修補術(shù)的手術(shù)病人共計287例。通過統(tǒng)計患者的人口學特征、吸煙史、糖尿病及高血壓病史、顱骨缺損病因、面積、兩次手術(shù)時間間隔、術(shù)后并發(fā)癥及二次手術(shù)情況,分析顱骨修補手術(shù)并發(fā)癥情況及其相關(guān)危險因素。 結(jié)果：顱骨修補術(shù)后并發(fā)癥發(fā)生率為10.45%。其中術(shù)后出現(xiàn)頭皮感染或顱內(nèi)感染的患者最多,發(fā)生率為3.83%,其次為術(shù)后繼發(fā)性癲癇(2.79%)及繼發(fā)性腦積水(2.04%)。顱骨修補術(shù)后出現(xiàn)并發(fā)癥的患者平均年齡為48.10±10.90歲,未出現(xiàn)并發(fā)癥的患者平均年齡為43.65±13.57歲,兩者具備顯著性差異(p=0.046)。術(shù)后出現(xiàn)并發(fā)癥患者顱骨缺損面積為114.93±40.43cm2,無并發(fā)癥組顱骨缺損面積為92.94±42.08cm2。兩者具備顯著性差異(p=0.007)。患者首次手術(shù)行去骨瓣減壓至二次顱骨修補手術(shù)時間間隔平均為4.42±3.30月,其中并發(fā)癥組平均時間為7.23±8.35月,無并發(fā)癥組平均時間為4.09±1.79月,兩者具備顯著性差異(p0.001)。顱骨缺損患者中因顱腦外傷行去骨瓣減壓術(shù)最多,占81.18%,出現(xiàn)顱骨修補術(shù)后并發(fā)癥者共計26例,發(fā)生率11.16%。高血壓腦出血行去骨瓣減壓患者共計22例(7.67%),顱骨修補術(shù)后并發(fā)癥發(fā)生率為9.09%。動脈瘤、大面積腦梗死、顱腦腫瘤患者行顱骨修補術(shù)后并發(fā)癥發(fā)生率分別為5.88%、11.11%、0。經(jīng)檢驗不存在顯著性差異。 結(jié)論：本次研究中,顱骨修補術(shù)后并發(fā)癥發(fā)生率較高,達到10.45%,包括繼發(fā)性癲癇,腦積水,頭皮或顱內(nèi)感染,顱內(nèi)血腫和死亡等,其中術(shù)后感染發(fā)生率最高,達到3.83%。并發(fā)癥發(fā)生的危險因素包括高齡、大面積顱骨缺損、較長的手術(shù)時間間隔。
[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 鹵10.90 years old, and the average age of the patients without complications was 43.65 鹵13.57 years old. There was a significant difference between the two groups. The area of skull defect was 114.93 鹵40.43 cm ~ 2 in patients with postoperative complications, and 92.94 鹵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 鹵3.30 months, the average time of complication group was 7.23 鹵8.35 months, and that of non-complication group was 4.09 鹵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.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R651.1

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相關(guān)期刊論文 前2條

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本文編號：1960968