脑室腹腔分流术配合不同时期颅骨修补治疗脑外伤疗效及对神经功能的影响

Effect of intraventricular celiac shunt combined with skull repair at different times on brain trauma and its effect on neurological function

目的:研究分析脑室腹腔分流术配合不同时期颅骨修补治疗创伤性颅脑外伤的临床疗效及对患者神经功能的影响。方法:86例创伤性颅脑外伤患者,根据颅骨修补时期的不同分为对照组和观察组,每组各43例。对照组患者脑室腹腔分流术后3个月行颅骨修补术,观察组患者在实施脑室腹腔分流术同期给予颅骨缺损修补术治疗。比较两组临床疗效、并发症以及手术前、后活动能力和神经功能。结果:观察组临床疗效97.67%,高于对照组的76.74%,差异有统计学意义(P<0.05);观察组患者术前的ADL及Fugl-Meyer评分与对照组相比,差异无统计学意义(P>0.05);术后30 d,两组患者的ADL及Fugl-Meyer评分均较术前提高显著,且观察组上升幅度更大,差异有统计学意义(P<0.05);观察组术后15 d、30 d NIHSS评分比对照组低,差异有统计学意义(P<0.05);观察组术后并发症发生率11.63%低于对照组的27.91%,差异有统计学意义(P<0.05)。结论:创伤性颅脑损伤患者给予颅骨缺损修补术联合早期脑室腹腔分流术治疗效果确切,有助于改善患者日常活动能力和四肢运动功能,促进神经功能恢复,减少并发症发生,利于预后,值得积极应用推广。

Objective： To study the effect of intraventricular celiac shunt combined with skull repair at different times on traumatic brain injury and its effect on neurological function. Methods： 86 cases of patients with traumatic brain trauma were selected as study subjects. All the patients were divided into control group and observation group according to the different time of skull repair,each group had 43 cases. In the control group,cranial repair was performed 3 months after abdominal cavity shunt. The patients in the observation group were treated with intraventricular celiac shunt for skull and defect repair at the same time. The clinical efficacy,complications,preoperative and postoperative activities,and neurological function were compared between the two groups. Results： The clinical efficacy of the observation group was 97. 67%,which was higher than that of the control group（ 76. 74%）,the difference was statistically significant（ P〈0. 05）. There was no significant difference in preoperative ADL and Fugl-Meyer scores between the two groups（ P〉0. 05）. 30 days after surgery,the ADL and Fugl-Meyer scores of the two groups were significantly higher than those before surgery,and the increasing was greater in the observation group（ P〈0. 05）. The NIHSS scores of the observation group on the 15 d and 30 d after surgery were lower than those of the control group,and the difference was statistically significant（ P〈0. 05）. The incidence of complications in the observation group was 11. 63%,which was lower than that（ 27. 91%,P〈0. 05） in the control group. Conclusion：The effect of the repair of skull defect combined with early ventriculoperitoneal shunt for the patients with traumatic brain injury is accurate. It can help to improve the daily activities of patients,the function of limbs,promote the recovery of neurological function,reduce the occurrence of complications,and is benefit to prognosis,it is worthy of active application and promotion.