单纯颅骨修补对去骨瓣后脑积水的影响
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作者单位:

南华大学附属第二医院 神经外科,湖南 衡阳 421000

作者简介:

高奇(1987—),男,主治医师,硕士,主要从事颅骨缺损与颅骨修补方面的研究。

通信作者:

廖勇仕(1963—),男,主任医师,本科,硕士研究生导师,主要从事胶质瘤离子通道方面的研究。Email:liaoys66@163.com。

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Effect of simple cranioplasty on hydrocephalus after decompressive craniectomy
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Affiliation:

Department of Neurosurgery, Affiliated Hospital of University of South China, Hengyang, Hu’nan 421000, ChinaCorresponding auther: LIAO Yong-Shi, E-mail: liaoys66@163.com

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    摘要:

    目的 探讨单纯颅骨修补对去骨瓣后脑积水患者的影响。方法 选取2017年9月—2020年9月南华大学附属第二医院神经外科收治的112例颅骨修补患者行双向队列研究,根据术前脑积水的情况分为观察组(有积水)40例和对照组(无积水)72例,比较两组术前状态、术后并发症情况、脑室变化、Barthel生活量表指数、简明精神状态量表(MMSE)评分等。结果 观察组年龄、缺损面积及动脉瘤患者人数均高于对照组(P<0.05),两组并发症发生率并无差异(P>0.05);术后随访结果显示,观察组术后脑室缩小人数比率多于对照组,但缩小程度不足以使其脱离脑积水的范畴(P<0.05);两组Barthel评分及MMSE评分均有提高(P<0.05),评分改善率无差异(P>0.05)。相关性分析发现,脑积水患者术后评分改善与脑室变化无相关性(P>0.05)。结论 对去骨瓣后脑积水患者实施单纯颅骨修补是安全的,尽管脑室扩大无法变回正常,但多数脑积水患者的神经功能及生活质量可得到改善。

    Abstract:

    Objective To investigate the effect of simple cranioplasty on hydrocephalus after decompressive craniectomy.Methods A two-way cohort study was performed for 112 patients who underwent cranioplasty in Department of Neurosurgery, The Second Affiliated Hospital of University of South China, from September 2017 to September 2020, and according to the presence or absence of hydrocephalus before surgery, the patients were divided into observation group (40 patients with hydrocephalus) and control group (72 patients without hydrocephalus). The two groups were compared in terms of preoperative condition, postoperative complications, ventricular changes, Barthel index, and Mini-Mental State Examination (MMSE) score.Results Compared with the control group, the observation group had significantly higher age, defect area, and number of patients with aneurysm (P <0.05), while there was no significant difference in the incidence rate of complications between the two groups (P >0.05). The patients were followed up at ≥3 months after surgery, and compared with the control group, the observation group had a significantly higher proportion of patients with a reduction in the ventricle after surgery, but such reduction did not help the patients recover from hydrocephalus (P <0.05). Both groups had significant increases in Barthel and MMSE scores (P <0.05), but there was no significant difference in the improvement rate of these scores between the two groups (P >0.05). The correlation analysis showed that there was no significant correlation between postoperative score improvement and ventricular changes in patients with hydrocephalus (P >0.05).Conclusions Simple cranioplasty is safe in patients with hydrocephalus after decompressive craniectomy. Although ventricular enlargement cannot return to normal, most patients with hydrocephalus may achieve the improvements in neurological function and quality of life.

    表 6 两组评分改善率比较 例(%)Table 6
    表 5 两组评分改善情况Table 5
    表 1 两组患者术前差异比较Table 1
    图1 同一患者DC术后头颈CTFig.1
    图2 脑积水患者手术示意Fig.2
    图3 观察组CP前后额角宽度对比Fig.3
    图4 对照组CP前后额角宽度对比Fig.4
    图5 观察组脑室缩小患者Evan’s指数与标准比较Fig.5
    图6 对照组脑室扩大患者Evan’s指数与标准比较Fig.6
    表 3 两组脑室变化情况比较 例(%)Table 3
    表 4 两组术前、术后评分情况对比Table 4
    表 2 并发症发生率比较 例(%)Table 2
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引用本文

高奇,廖勇仕,王兵,周敏456.单纯颅骨修补对去骨瓣后脑积水的影响[J].国际神经病学神经外科学杂志,2021,48(5):429-434111GAO Qi, LIAO Yong-Shi, WANG Bing, ZHOU Min.222. Effect of simple cranioplasty on hydrocephalus after decompressive craniectomy[J]. Journal of International Neurology and Neurosurgery,2021,48(5):429-434

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  • 收稿日期:2020-12-28
  • 最后修改日期:2021-09-28
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  • 在线发布日期: 2021-11-15
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