不同时机行颅骨修补术对脑外伤所致颅骨缺损伴脑积水患者预后的影响

Effect of cranioplasty at different time on prognosis of patients with skull defect and hydrocephalus caused by cerebral trauma

目的探讨不同时机行颅骨修补术对脑外伤所致颅骨缺损伴脑积水患者预后的影响。方法选取2015年5月至2017年10月在信阳市第四人民医院择期行手术治疗的脑外伤后颅骨缺损伴脑积水患者94例,按抽签法分为两组,每组47例。对照组先行脑室-腹腔分流术,2~3个月后行颅骨修补术,研究组同期行脑室-腹腔分流术与颅骨修补术,比较两组预后效果、日常生活能力及肢体运动功能、并发症。结果研究组预后总良好率(87.23%)高于对照组(70.21%),差异有统计学意义(P<0.05);术后6个月,研究组ADL评分(72.33±13.16)分、Fugl-Meyer评分(78.18±8.62)分均高于对照组[(52.85±13.54)分、(60.11±9.41)分],差异有统计学意义(P<0.05);研究组术后并发症发生率(10.64%)低于对照组(27.66%),差异有统计学意义(P<0.05)。结论脑外伤所致颅骨缺损伴脑积水患者采用同期行脑室腹腔分流术与颅骨修补术治疗可提高患者日常生活能力及肢体运动功能,降低并发症发生率,改善其预后。

Objective To investigate the effect of cranioplasty at different time on prognosis of patients with skull defect and hydrocephalus caused by cerebral trauma . Methods A total of 94 patients with skull defect and hydrocephalus received elective surgery from May 2015 to October 2017 in the Fourth People’s Hospital of Xinyang were selected, and they were divided into two groups by draw lots, with 47 cases in each group. The control group was given ventriculo-peritoneal shunt, and then was given cranioplasty after 2-3 months, The research group was given simultaneous ventriculo-peritoneal shunt and cranioplasty. The prognosis, activity of daily living, limb movement function, complications between the two groups were compared. Results The total excellent rate of prognosis in research group (87.23%) was higher than that of control group (70.21%, P<0.05);after surgery for 6 months, the scores of ADL and Fugl-Meyer in research group[(72.33±13.16)points,(78.18±8.62)points] were higher than control group[(52.85±13.54)points,(60.11±9.41)points], P<0.05;the incidence of postoperative complications in research group (10.64%) was lower than control group (27.66%), P<0.05. Conclusions Simultaneous ventriculo-peritoneal shunt and cranioplasty in treatment of patients with skull defect and hydrocephalus caused by cerebral trauma can increase activity of daily living, limb movement function, decrease the incidence of complications and improve prognosis.