硬膜双层修补在额颞区大骨瓣减压术后颅骨缺损修补中的临床效果研究

Clinical effect of dura mater bilayer repair in skull defect repair after large decompressive craniectomy

目的探讨硬膜双层修补在额颞区大骨瓣减压术后颅骨缺损修补中的临床效果。方法选取2014年2月至2016年2月本院收治的120例额颞区大骨瓣减压术后颅骨缺损患者为研究对象,根据患者于本院行硬膜双层修补时间(以2015年1月1日为节点)不同,将其分为观察组(2015年1月1日前,62例)和对照组(2015年1月1日后,58例)。观察组患者行硬膜双层修补术,对照组患者行硬膜单层修补术。记录和比较两组患者的手术时间、术中出血量、引流管拔除时间及住院天数;记录和观察术前1天(T1)、术后7天(T2)、术后14天(T3)两组患者的认知功能、运动功能及日常生活能力。术前1天和术后3个月,采用磁共振灌注加权成像评估患者脑灌注情况,记录并比较两组患者灌注异常指数(perfusion abnormality index,PAI)。结果观察组患者住院天数和引流管拔除时间均显著短于对照组(P<0.05),两组患者手术时间和术中出血量比较均无显著差异(P>0.05)。两组患者简易精神状况检查(mini-mental state examination,MMSE)量表评分随时间延长显著上升(P<0.05),神经功能缺损程度评分随时间延长显著下降(P<0.05)。T2和T3时,观察组患者术后MMSE量表评分均显著高于对照组(P<0.05),神经功能缺损程度评分均显著低于对照组(P<0.05)。观察组患者并发症发生率显著低于对照组(P<0.05)。术后3个月,两组患者PAI较术前1天均显著下降(P<0.05),且观察组患者PAI显著低于对照组(P<0.05)。结论硬膜双层缝合在额颞区大骨瓣减压术后颅骨缺损修补中的效果明显,手术时间较短,术中出血量较少,术后并发症发生率较低。

Objective To investigate the clinical effect of dura mater bilayer repair in skull defect repair after large decompressive craniectomy. Method 120 cases of defect of skull patients after large decompressive craniectomy in frontal and temporal region were selected as the research objects in our hospital from February 2014 to February 2016, they were divided into observation group（admitted before January 1, 2015, 62 cases） and control group（admitted after January 1, 2015, 58 cases）, observation group patients were given dura mater bilayer repair, control group patients were given dura mater monolayer repair. Operation time, amount of intraoperative bleeding, extraction time of drainage tube and hospital day were recorded and compared between the two groups. Cognitive function, motor function and ability of daily living were recorded by at 1 day before operation（T1）, 7 days after operation（T2）, 14 days after operation（T3）. Perfusion weighted imaging（PWI） scan was used to evaluate cerebral perfusion at 1 day before operation and 3 months after operation, and the perfusion abnormality index（PAI） was recorded and compared between the two groups. Result The hospital day and extraction time of drainage tube of observation group were significantly shorter than those of control group（P〈0.05）. There were no significant differences in operation time and amount of intraoperative bleeding between the two groups（P〈0.05）. Mini-mental state examination（MMSE） scores of the two groups were significant increased with time（P〈0.05）, neurological defect scores of the two groups were significantly decreased with time（P〈0.05）. At T2 and T3, the MMSE score of observation group was significantly higher than that of control group（P〈0.05）, neurological defect score of observation group was significantly lower than that of control group（P〈0.05）. The incidence of complications of observation group was lower than that of control group（P〈0.05）. At 3 months after operation, PAI of the two groups were significantly lower than those at 1 day before operation（P〈0.05）, PAI of observation group was significantly lower than that of control group（P〈0.05）. Conclusion Dura mater bilayer repair in skull defect repair after large decompressive craniectomy is effective. The operation time is shorter and the amount of intrao perative bleeding is less, the incidence of postoperative complications is lower.