【摘要】：為了探索顱骨缺損手術(shù)時(shí)機(jī)與方法的優(yōu)化措施并對(duì)效果進(jìn)行評(píng)價(jià),我們結(jié)合臨床實(shí)踐,引進(jìn)先進(jìn)手術(shù)技術(shù),標(biāo)準(zhǔn)化手術(shù)術(shù)式,規(guī)范適應(yīng)癥的選擇標(biāo)準(zhǔn),開展顱骨缺損的早期修補(bǔ)。臨床效果分析表明手術(shù)難度、手術(shù)風(fēng)險(xiǎn)大大降低,患者住院天數(shù)縮短,總費(fèi)用下降,并有助于神經(jīng)功能的早期恢復(fù),效果明顯。筆者從巴彥淖爾市、鄂爾多斯市的四所醫(yī)院選取了 83例顱骨缺損的患者,依照納入的標(biāo)準(zhǔn)按時(shí)間將修補(bǔ)手術(shù)患者分成三組。所有納入標(biāo)準(zhǔn)的患者,除常規(guī)檢驗(yàn)、放射、心電圖等準(zhǔn)備外,術(shù)前要進(jìn)行頭部CT的薄層掃描,了解顱內(nèi)情況,并在缺損區(qū)域進(jìn)行三維重建。手術(shù)麻醉的方法都選用全麻下氣管插管麻醉。手術(shù)方式是常規(guī)的手術(shù)方法。分析結(jié)果表明所有患者都手術(shù)順利,平安出院,而且都獲得了隨訪,平均隨訪時(shí)間為6個(gè)月。顱骨缺損患者修補(bǔ)術(shù)后,顱骨缺損綜合征均消失,患者原有的神經(jīng)功能障礙也都有不同程度的好轉(zhuǎn)�；颊咝g(shù)后神經(jīng)功能的恢復(fù)情況統(tǒng)計(jì)結(jié)果可以看出早期組的恢復(fù)率最高,可以達(dá)到83.3%,對(duì)比明顯,常規(guī)時(shí)間組的神經(jīng)功能恢復(fù)率最差僅為62.5%。早期組內(nèi)對(duì)比得出并非手術(shù)時(shí)間越靠前神經(jīng)功能恢復(fù)越好,而是在首次手術(shù)后的第三周及第四周行顱骨修補(bǔ)術(shù),神經(jīng)功能恢復(fù)率最高。通過對(duì)患者術(shù)后的并發(fā)癥進(jìn)行統(tǒng)計(jì)比對(duì)分析,早期手術(shù)組與常規(guī)時(shí)間手術(shù)組、中期手術(shù)組與常規(guī)時(shí)間手術(shù)組的比較均具有統(tǒng)計(jì)學(xué)意義(p0.05)。另外對(duì)患者顱骨修補(bǔ)術(shù)后2周隨訪比對(duì)后發(fā)現(xiàn),早期手術(shù)組、中期手術(shù)組與常規(guī)時(shí)間手術(shù)組的患者在GCS評(píng)分及GOS的評(píng)分比較分析無統(tǒng)計(jì)學(xué)意義(p0.05),而在修補(bǔ)術(shù)后6個(gè)月的隨訪中,患者在這倆種評(píng)分中均具有統(tǒng)計(jì)學(xué)意義(均p0.05),但早期手術(shù)組及中期手術(shù)組之間比較仍然無統(tǒng)計(jì)學(xué)意義(p0.05)。這也就表明筆者在顱骨缺損修補(bǔ)手術(shù)時(shí)機(jī)和手術(shù)方法的選擇上已經(jīng)取得了理想的結(jié)果。綜上所述,早期的顱骨缺損修補(bǔ)手術(shù)可以使所有患者的顱骨缺損綜合征消失,而且原有的神經(jīng)功能的障礙問題也在修補(bǔ)手術(shù)后有不同程度的好轉(zhuǎn);其次在患者精神心理上的康復(fù)也能起到積極的作用,可以使患者早日融入社會(huì),促進(jìn)患者身心的早日康復(fù)。另外早期行顱骨缺損的修補(bǔ)手術(shù),在縮短患者病程、減少治療費(fèi)用方面都有較好的效果,的確具有推廣的價(jià)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.
【學(xué)位授予單位】：內(nèi)蒙古大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.1

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