不同时期颅骨修补术前后CT灌注与临床预后相关性研究

Correlation research on CT perfusion before and after the skull defect repair for patients in different operation period and the clinical prognosis

目的探讨不同手术时期颅骨缺损修补患者的CTP改变,为临床上颅骨修补治疗时机的选择及临床预后评估提供理论依据。方法收集我院神经外科2014年7月至2015年1月收治的40例颅骨缺损修补患者的临床及影像学资料,将患者按照不同手术时机分为两组,A组(颅骨修补≤1.5月)和B组(颅骨修补>1.5月),所有患者分别于术前1周和术后3周行CTP灌注扫描。通过CTP、脑电地形图检查,收集颅骨缺损修补手术前后缺损区大脑皮层脑血流量变化的参数值、脑电活动变化情况,对比不同原因发病行颅骨缺损修补术前后的脑皮层血流灌注、脑电变化、神经功能缺失改善情况、术后手术并发症发生率及生活质量改善等情况,并进行统计学分析。结果由不同原因(硬脑膜外血肿、硬脑膜下血肿、脑内血肿等)导致的颅骨缺损患者脑血流灌注各不相同;术后,各原因导致颅骨缺损的患侧CBF较术前均得到改善;两组患者术前患侧大脑皮层区域的CBF均较健侧显著性降低(P<0.05);术后3周,两组患侧大脑皮层区CBF较术前均显著上升(P<0.05);术后两组相比,A组较B组患侧脑组织血流灌注增加更加明显;颅骨修补术前脑电地形图检查无明显变化;修补术前两组Karnofaky评分无显著性差异(P>0.05);术后A组Karnofaky评分明显高于B组,差异具有统计学意义(P<0.05);两组住院期间,A组并发症4例(1例创口感染,3例硬膜下积液),B组并发症9例(1例创口感染,硬膜下积液8例)。结论与常规颅骨修补相比,超早期颅骨修补对大脑皮层的血流灌注的改善效果更明显,不良反应和并发症更少,更有利于患者术后神经功能的恢复。

Objective To explore the change of CTP in patients with skull defect repair in different operation timing,and to provide a theoretical basis for the selection of treatment timing and clinical prognosis. Methods Clinical and imaging data of 40 patients receiving skull defect repair operation in the department of neurosurgery of our hospital from July 2014 to January 2015 were selected, and were divided into two groups according to different surgical timing, they were group A（skull repair≤1.5 months） and group B（〉1.5 month）. All the patients received CTP 1 week before and three weeks after the surgery. According to surgical repair by CTP and BEAM examination, the changes of cerebral blood flow and changes in brain electrical activity of the cerebral cortex in the defect area before and after the surgery were collected, and the cerebral blood flow, cerebral cortex EEG changes, CBF, neurological deficits improving the situation, incidence of postoperative complications life quality improvement and other changes before and after the skull defect repair surgery of patients in different operation timing were compared and statistical analyzed were carried out. Results Cerebral blood flow perfusion were different in patients with skull defects caused by different primary diseases（epidural hematoma, subdural hematoma, brain hematoma, etc.）. After the operation, the CBF in affected side of all patients were improved and the cerebral cortex CBF in the two groups was significantly lower than that in the contralateral cerebral cortex（ P〈0.05）. After 3weeks, the cerebral cortex CBF of patients in the two groups were significantly higher than that before the surgery（ P〈0.05）;when compared with group B, the increasing of cerebral blood flow perfusion of group A is higher. The brain electrical activity mapping and Karnofaky scores of the two groups before the surgery have no significant difference（ P〈0.05）,however, the Karnofaky score of group A was significantly higher than that of group B, and the difference was statistically significant（P〈0.05）. During hospitalization, the complications in group A were 4 cases（1 case of wound infection, 3 cases of subdural effusion） and the complications in group B were 9 cases（1 case of wound infection, 8 cases of subdural effusion）.Conclusion Compared with the conventional patch skull repair, skull patch ultra-early-improving can significantly improve the blood perfusion of the cerebral cortex. It has less side effects and complications, and therefore has more benefit for the recovery of neural function.