免缝胶原海绵人工硬脑膜在颅脑损伤大骨瓣减压术中的应用

Application of collagen sponge artificial dura without suturing to big bone flap decompression after traumatic brain injury

目的探讨免缝胶原海绵人工硬脑膜在颅脑损伤大骨瓣减压术中的应用效果。方法 2012年1月至2015年12月收治颅脑损伤108例,采用免缝胶原海绵人工硬脑膜修补54例（观察组）,采用可缝合人工硬脑膜补片修补54例（对照组）。术后3～6个月常规行颅骨修补术。结果观察组硬脑膜修补时间明显缩短（P〈0.05）,两组术后并发症发生率、术后6个月GOS评分均无显著差异（P〉0.05）。观察组修补硬脑膜至颅骨修补术时间间隔、修补术时间、修补术中出血量、脑膜破裂率均明显低于对照组（P〈0.05）。结论免缝胶原海绵人工硬脑膜在颅脑损伤中能够发挥减压作用,保护脑功能,手术时间短,与严密缝合的人工硬脑膜修补术效果相当,并且更有利于二期颅骨修补术的开展。

Objective To explore the value of application of the collagen sponge artificial dura without suturing to big bone flapdecompression after severe traumatic brain injury（TBI）.Methods The clinical data of 108 patients with severe TBI who underwent bigbone flap decompression were analyzed retrospectiely. Of these 108 patients, 54 received the repair of dura mater with collagen spongeartificial idura without suturing in the observed group and 54 with the routine artificial dura in the control group. The operating time fordural repair, rate of postoperative complications, time interval from hematoma clearance to cranioplasty, operative time for cranioplasty,intraoperative blood loss volume, rate of dural damage and GOS scores 6 months after the operation were analyzed in the two groups.Results There were insignificant differences in the rate of postoperative complications（1.85% vs 7.41%） and GOS score 6 months afterthe operation between both the groups（P0.05）. There were significant differences in the operating time for dura repair [those in theobserved and control group were（5.23 ± 1.25） min and（12.58 ± 2.65） min respectively], time interval from hematoma clearance tocranioplasty [those in the observed and control groups were（115.78±21.56） days and（217.64±34.32） days respectively], operative timefor cranioplast [those in the observed and control groups were（73.25 ± 7.62） min and（98.63 ± 11.58） min respectively], intraoperativeblood loss volume [those in the observed and control groups were（66.45±18.52） ml and（101.34±21.78） ml respectively], rate of damageto dura mater [those in the observed and control groups were 4% and 14.29% respectively） between both the groups（P0.05）.Conclusions The collagen sponge artificial dura without suturing is similar to the routine artificial dura with tightly suturing in the repaireffect on the dura mater in the patients with severe TBI undergoing the big bone flap decompression, but the former can reduced duralperpair and cranioplasty time and intraoperative blood loss volume compared to the latter. Therefore collagen sponge artificial durawithout suturing is of value to spreading use clinically.