颅脑损伤去骨瓣术后并交通性脑积水临床治疗

Clinical Treatment of Craniocerebral Trauma Combined With Communicating Hydrocephalus After Decompressive Craniectomy

目的探讨分期行脑积水分流与颅骨修补手术治疗颅脑损伤去骨瓣术(DC)后合并交通性脑积水的临床效果。方法临床纳入本院2016年8月—2018年2月收治的82例颅脑损伤患者作为研究对象,随机将全部入选者分为研究组、对照组,均为41例。对照组先行颅骨修补术,术后1个月内再行脑积水分流术。研究组患者首先行脑积水分流术,于术后1个月内再行颅骨修补术。分析对比两组手术时间、术后并发症发生率,并将两组治疗前、后GOS、GCS评分进行对比。结果两组颅骨修补术、脑积水分流术时间相近,差异无统计学意义(t=0.808、P=0.422,t=0.463、P=0.644);研究组术后并发症发生率为2.44%,与对照组的9.76%相比明显更低,差异有统计学意义(χ2=4.677、P=0.031);研究组与对照组治疗前GOS、GCS评分比较差异无统计学意义;治疗后研究组GOS、GCS评分较对照组变化更明显(t=3.975、P=0.000,t=3.630、P=0.000)。结论按脑积水分流术、颅骨修补术的顺序治疗DC后合并交通性脑积水效果更理想,有利于减少术后并发症的发生,减轻颅脑神经系统损伤,提高手术效果。

Objective To discuss the effect of staging hydrocephalus shunt and cranioplasty in craniocerebral injury with communicating hydrocephalus after the decompressive craniectomy.Methods 82 patients with craniocerebral injury treated from August 2016 to February 2018 in our hospital were selected.The subjects were randomly assigned to two groups,41 cases in each group.The control group firstly adopted the cranioplasty and then hydrocephalus shunt within 1 month;the study group firstly adopted the hydrocephalus shunt and then cranioplasty within 1 month.The operation time,incidence rate of postoperative complications,GOS(Glasgow outcome scale)and GCS(Glasgow coma scale)scores were compared.Results The time of taking the cranioplasty and hydrocephalus shunt for two groups was not significantly different(t=0.808,P=0.422;t=0.463,P=0.644);the incidence rate of postoperative complications in the study group was significantly lower than control group(2.44%vs.9.76%)(χ^2=4.677,P=0.031);before treatment,there were no significant between group difference in the GOS and GCS scores;after treatment,the GOS and GCS scores in the study group were significantly better than control group(t=3.975,P=0.000;t=3.630,P=0.000).Conclusion The staging hydrocephalus shunt and cranioplasty has a better effect in craniocerebral injury with communicating hydrocephalus,can reduce the incidence rate of postoperative complications,relieve the nervous system impairment and increase the effective rate.It is worthy of clinical application and promotion.