早期与中期颅骨修补术和脑室腹腔分流术治疗脑外伤的临床差异探讨

Clinical difference between the effect of early stage and medium-term cranioplasty following ventriculoperitoneal shunt for the treatment of cerebral trauma

目的探讨早、中期颅骨修补术和脑室腹腔分流术治疗脑外伤的临床疗效,为脑外伤的临床治疗提供更加客观的依据。方法选取2014年1月~2016年1月于诊治的60例颅脑外伤后行开颅去骨瓣减压术后并发脑积水的患者,将入选研究对象依据随机数表方法随机分为两组即对照组与观察组两组,每组患者各30例,对照组患者的手术方式为先行脑室腹腔分流术,在分流术后的3~6个月时间内行颅骨修补术(即中期颅骨修补),观察组患者的手术方式为早期同时行颅骨修补术和脑室腹腔分流术,统计、观察与比较两组患者经手术治疗后的格拉斯哥昏迷评分及格拉斯哥临床预后评分、术后相关并发症的发生情况等。结果与对照组相比较,观察组患者手术治疗后其患者的格拉斯哥昏迷评分的优良率(73.33%)显著高于对照组患者(56.67%),其差异具有统计学意义(P<0.05);术后观察组格拉斯哥疗效评估优于对照组,差异具有统计学意义(P<0.05);在术后临床相关并发症的发生率方面,观察组发生率低于对照组,差异具有统计学意义(P<0.05)。结论在颅脑外伤的外科治疗中,运用早期颅骨修补术和脑室腹腔分流术可以有效改善患者的神经功能障碍及临床疗效,降低术后相关并发症的发生率,是一种可行的外科治疗手段,值得临床推广应用。

Objective To explore the clinical effect of early stage and medium-term crauioplasty following ventriculoperitoneal shunt （VPS） in the treatment of cerebral trauma, and therefore provide objective basis for the treatment. Methods Clinical data of 60 cerebral trauma patients complicated with hydrocephalus after decompressive craniectomy hospitalized in our department from Jan 2014 to Jan 2016 were analyzed retrospectively. All the patients were randomly divided into 2 groups, each group had 30 cases. The patients of the control group received initial VPS and cranioplasty 3 to 6 months after VPS （mid-term stage cranioplasty）, while those of the observation group received simultaneous cranioplasty and VPS （ early stage cranioplasty）. The evaluation scores of Glasgow coma scale （ GCS）, Glasgow outcome scale （GOS） , and incidences of complications in the two groups were recorded and compared. Results The postoperative rate of excellent and good GCS of the observation group （73.33%） was significantly higher than that of the control group （56.67%）（P 〈0.05）, while the GOS of the observation group was also superior to that of the control group （ P 〈 0.05 ）. The incidence of complications of the observation group was significantly lower than that of control group （P 〈 0.05 ）. Conclusions For patients with craniocerebra! trauma, the early stage cranioplasty and VPS can effectively improve the clinical effect and neurological function and reduce the incidence of complications. It is worthy of clinical application and promotion.