颅骨缺损后不同时间修补术对病人脑血流动力学影响

INFLUENCE OF CRANIOPLASTY PERFORMED AT DIFFERENT TIME POINTS AFTER CRANIAL DEFECT ON CEREBRAL HEMODYNAMICS

目的探讨不同手术时间段颅骨缺损修补术对颅骨缺损病人脑血流动力学影响。方法拟行单侧颅骨缺损修补术病人62例,根据手术时间不同分为缺损修补术<12周组(早期组)和缺损修补术≥12周组(晚期组),每组各31例。于颅骨修补术前5d内和术后12d内,采用256排螺旋CT行脑灌注扫描,记录患侧大脑皮质、基底核和丘脑区域灌注图像上局部脑血容量(rCBV)、局部脑血流量(rCBF)、对比剂平均通过时间(MTT)和对比剂达到峰值时间(TTP)参数值。分析两组病人手术前后rCBV、rCBF、MTT和TTP改变量。结果早期组患侧大脑皮质和基底节区手术前后rCBF的改变量高于晚期组(t=5.32、7.26,P<0.05);早期组基底节区手术前后MTT的改变量较晚期组更明显(t=10.73,P<0.05)。结论早期颅骨修补更有利于改善颅骨缺损病人脑血流动力学和脑灌注状况。

Objective To investigate the influence of cranioplasty performed at different time points after cranial defect on cerebral hemodynamics. Methods A total of 62 patients who planned to undergo unilateral cranial defect repair were divided into early-repair group（within 12 weeks after cranial defect）and late-repair group（≥12weeks after cranial defect）,with 31 patients in each group.256-slice spiral CT for cerebral perfusion scan was performed within 5days before repair and within 12 days after repair to record the values of regional cerebral blood volume（rCBV）,regional cerebral blood flow（rCBF）,mean transit time（MTT）of contrast agent,and time to peak（TTP）of contrast agent on the perfusion images of the affected cerebral cortex,basal ganglia,and thalamus.The changes in rCBV,rCBF,MTT,and TTP after surgery were analyzed in both groups. Results Compared with the late-repair group,the early-repair group had significantly greater changes in rCBF in the affected cerebral cortex and basal ganglia（t=5.32,7.26;P〈0.05）and MTT in the basal ganglia after surgery（t=10.73,P〈0.05）. Conclusion Early cranioplasty helps to improve cerebral hemodynamics and cerebral perfusion in patients with cranial defect.