减压术后脑膨出患者早期颅骨修补临床治疗分析(1)
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【摘要】 目的 探讨开颅去骨瓣减压术后脑膨出患者早期颅骨修补的方法及治疗效果。方法 将29例患者按照导致脑膨出的具体原因分为三组:脑积水组、脑软化囊变组及硬膜下/纵裂积液组,术中颅骨修补时分别针对不同病因做了相应处理。结果 本组无手术死亡患者。术后共有7例出现并发症,经分别处理后恢复良好。其余患者均恢复良好,随访3~6个月,术后意识障碍、认知能力及肌张力等较术前得到不同程度的改善。结论 去骨瓣减压术后脑膨出患者早期行颅骨修补,并同期去除引起膨出的诱因,临床治疗效果明显,是一种有效可行的治疗手段。
【关键词】减压术;脑膨出;颅骨修补
The early treatmeat strategies of cranioplasty for encephalocele patients after decompression surgery
LIU Yong sheng,SONG Lai jun.Department of Neurosurgery,the First People’s Hospital of Shangqiu,Henan,Shangqiu,476005,China
【Abstract】 Objective To study the methods and effects of the early cranioplasty treatmeat for encephalocele patients after decompression surgery.Methods The 29 patients in accordance with the specific reasons leading to encephalocele were divided into three groups:hydrocephalus,brain softening cystic group and subdural/longitudinal fluid group,.with cranioplasty surgery,the treatment was did respectively corresponding to different causes.Results There was no operative mortality.There were 7 patients with complications after operation.they had got separately good recovery after treatment.The remaining patients recovered well,Follow up 3 6 months,The patients were improved to varying degrees compared with that before operation in the disturbance of consciousness,cognitive ability and muscle strength.Conclusion Early stage cranioplasty was made in patients with encephalocele after decompressive craniectomy,and swelled the causes by removing the incentive for the same period,the clinical effect was significant.It is a feasible and effective treatment.
【Key words】Decompression; Brain swelling; Skull patch
重型颅脑损伤患者早期手术救治及去骨瓣减压是缓解颅内高压及降低致死率的重要方法,但术后脑膨出在此类患者中较常发生,传统的治疗方法是待3~6个月后行颅骨修补,患者往往错过了最佳的康复时期。本文回顾性总结了我院2006年6月至2009年10月间行颅骨修补的患者65例,其中伴有脑膨出并行早期修补的患者29例。我们在做颅骨修补的同时,根据不同的膨出原因,术中做了针对性处理,取得了满意的效果,现总结如下。
1 资料与方法
1.1 一般资料 本组男21例,女8例,年龄18~65岁。颅脑损伤20例,脑出血9例。左侧14例,右侧15例。去骨瓣减压手术在我院进行18例,减压术后由外院转入11例。主要临床表现为意识障碍、认知功能障碍、反应迟钝、肌张力增高等。查体可见骨窗明显膨出或下垂,张力较高。
1.2 影像学检查 所有患者术前均行头颅CT检查,依据结果将脑膨出患者分为3种类型,因脑积水所致膨出者15例,因脑软化囊变所致膨出者9例,因同侧或对侧硬膜下/纵裂积液所致者5例。据此29例患者分为脑积水组(A组)、脑软化囊变组(B组)及硬膜下/纵裂积液组(C组)。
1.3 手术时间及术前准备 颅骨修补时间距患者去骨瓣减压手术21~85 d,平均52 d。修补材料选用数字化EH复合型骨水泥(颅颌优)及三维塑形钛板两种材料。术前常规螺旋CT薄层扫描,将采集的数据通过CAD/CAM技术进行三维骨瓣成型 ......
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