颅骨缺损修补术并发症88例临床分析

Complications of repair of skull defects:Analysis of 88 cases

目的探讨颅骨缺损修补术的并发症及防治措施。方法回顾分析2005-07～2011-03收治的颅骨缺损修补术并发症88例患者的诊治效果。结果 340例颅骨修补术后并发症88例,主要有头皮下感染7例,材料外露4例,癫8例,术后颅内血肿14例,头皮下积液1例,头皮坏死1例,材料塌陷1例,材料变形1例,左下腹壁皮下血肿2例,左下腹壁软组织骨化8例,除外形明显缺陷41例未处理外均治愈。结论自体骨瓣、普通钛网、数字化预塑钛网材料与颅骨缺损修补术后感染、癫、颅内血肿无明显相关性。坚持无菌操作、良好塑形、操作轻柔、固定确切、无张力缝合皮瓣、持续皮下负压引流等为预防并发症的关键因素。

Objective To analyze the complications of repair of skull defects,and suggest some measures of cure and prevention for these complications.Methods Three hundred and forty cases of repair of skull defects had been done between July 2005 and March 2011,complications after the repair in 88 cases were analyzed retrospectively.Results Among 340 patients,complications were occurred in 88 cases,except 41 cases of obvious defect in shape without reoperation.The other complications including： 7 cases of subcutaneous infection,4 cases of exposure of the material,8 cases of epileptic attack,14 cases of postoperative intracranial hematoma,1 case of collection of fluid under the scalp,1 case of scalp necrosis,1 case of collapse of the material,1 case of deformation of the material,2 cases of sub cutanous liematoma of left low abdominal weall,8 cases of parechyma ossification of left low abdominal wall.Conclusion Autologous skull flap,common titanium mesh or digital pre-modeled titanium mesh have no significant correlation with postoperative infection,epilepsy and intracranial hematoma.The key factors for the prevention of complications are adhering to aseptic technique,good shaping,gentle operation,stable fixation,tension-free scalp flap suture,continuous subcutaneous negative pressure drainage,and so on.