早期颅骨修补及脑室腹腔分流在脑外伤治疗中的作用

Role of early cranioplasty and ventriculo-peritoneal shunt on the treatment of traumatic brain injury

目的探讨早期一次性颅骨修补及脑室腹腔分流在脑外伤治疗中的作用。方法回顾性分析2003年1月至2005年12月同期行颅骨修补及脑室腹腔分流的脑外伤病例34例,对其临床资料、并发症及预后进行总结。结果本组手术时机均在伤后3个月以内,术后并发分流管阻塞1例,颅内感染2例;术后意识及神经功能障碍不同程度改善30例(88%);恢复良好18例(53%),中残8例(24%),无手术死亡病例。结论颅脑损伤术后颅骨缺损、脑膨出、脑积水严重影响患者预后,早期并同期行颅骨修补及脑室腹腔分流术并发症少,可明显缓解患者意识及神经功能障碍,提高患者预后,值得临床进一步推广。

Objective To explore the role of early one-stage eranioplasty and ventrieulo-peritoneal shunt on the treatment of traumatic brain injury with hydrocephalus and skull defect. Methods The clinical records, complication and prognosis of 34 patients with hydrocephalus complicated by skull defect with onestage operation of eranioplasty and ventrieulo-peritoneal shunt were reviewed. Results All operation was performed within 3 months after trauma. The clinical complication of the patients was block of shunt tube in 1 ease, skull infection in 2 cases. The outcome of the patients was 30 eases improved with consciousness and nerve function and the prognosis was 18 eases got good recovery （53%） and 8 moderate deficit （24%）, no eases were dead due to operation. Conclusions The complications with skull defect, brain swell and hydrocephalus after traumatic brain injury operation influence the patient＇s prognosis significantly. There are fewer eomplieations with operation of early one-stage eranioplasty and ventrieulo-peritoneal shunt. And the operation ean improve eonseiousness and nerve funetion and the prognosis. It is good for generalizing on clinic.