外伤性颅骨缺损修补术前后CT脑灌注变化及其意义

The influence and significance of cranioplasty on CT perfusion in traumatic skull defect patients

目的研究外伤性颅骨缺损患者行修补术前后脑血流灌注变化及其意义。方法对20例重型颅脑外伤开颅去骨瓣减压术后颅骨缺损患者在修补术前和术后2周行64排螺旋CT脑灌注扫描,记录修补术前后双侧大脑皮层、基底节区等相关区域血流灌注图像上CBV、CBF、MTT及TTP等参数值,同时在上述2个时间点对患者神经症状变化情况进行评估。作手术前后自身对照分析。结果术后全部患者临床症状有不同程度好转;修补术前患侧皮质区CBF显著低于健侧;术后患侧皮质区CBF较术前明显上升;患侧基底节区脑血流相关数值在术后较术前无明显改善。结论颅骨修补术可提高患侧皮层区的脑血流灌注,进而改善相应受损的神经功能。

Objective To study the influence and significance of brain CT perfusion after cranioplasty. Methods Multiple spiral CT have been performed respectively to 20 patients with traumatic skull defect in 2 days before and 14 days after cranioplasty. The measurements of cerebral blood flow with CT perfusion were obtained. The neurological functional independent measure was assessed immediately before CT perfusion and 14 days after cranioplasty. Results Nneurological function were improved at different levels in all patients. The CBF of cortex before cranioplasty at injured side decreased with contralateral cortex with statistical significance. The CBF of cortex after cranioplasty at injured side increased with statistical significance. The CBF of cortex, basal nuclei on contralateral had no statistical significance. Conclusion Cranioplasty might promote CBF of injured cortex and improve neurological status.