脑外伤后颅骨缺损伴脑积水的临床疗效分析

Curative Effect Analysis on Patients with Skull Defect Accompanied by Hydrocephalus after Cerebral Trauma

目的探讨一期脑室-腹腔分流联合颅骨修补术对脑积水的临床效果。方法对于脑外伤后颅骨缺损伴脑积水的62例患者,分别随机采用一期脑室-腹腔分流联合颅骨修补术30例(A组),32例分期手术(B组)进行治疗。结果①疗效:两组间比较差异无统计学意义(P>0.05)。②并发症:A组分流过度、硬膜下积液及血肿的发生率分别为3.33%(1/30)和6.67%(2/30),B组分别为21.88%(7/32)和43.75%(14/32),两组比较差异有统计学意义(P<0.05);分流管堵塞、分流感染及切口脑脊液漏等并发症两组间差异无统计学意义(P>0.05)。结论一期联合手术能显著降低术后并发症,是脑外伤后脑积水合并颅骨缺损患者更为理想的治疗方法。

Objective To evaluate the curative effect of early synchronistic ventrieulo-peritoneal shunt and cranioplasty on the treatment of traumatic brain injury with hydrocephalus and skull defect. Methods 62 cases of skull defect with hydrocephalus were randomly divided into two groups. Group A （ n = 30） underwent synchronistic operations and group B （ n = 32 ） underwent staging operations as control. The complications and prognosis were compared between both groups. Results There was no signif- icant difference in the curative effect between the two groups （ P 〉 0.05 ）, but the rates of overdrainage and subdural hydroma / hematoma in group A（ 3.33% ,6.67% ） were significantly lower than those in group B （21.88% ,g3.75% ）, P 〈 0.05. There were no significant differences in the other complications between the two groups, such as shunt plug, shunts infection, cerebrospi- nal fluid leakage,et al. Conclusion The early synchronistic ventriculo-peritoneal shunt and cranioplasty is a better and more effective strategy for traumatic brain injury with hydrocephalus and skull defect as compared with staging operation.