颅脑损伤继发正常压力脑积水的临床治疗分析

Clinical analysis of normal pressure hydrocephalus secondary to tranmatic brain injury

目的探讨颅脑损伤继发正常压力脑积水的治疗方法及疗效。方法回顾性分析2017年1月至2019年9月收治的69例颅脑损伤继发正常压力脑积水的临床资料。采用腰大池-腹腔分流术(LPS)治疗31例(LPS组),采用脑室-腹腔分流术(VPS)治疗23例(VPS组),保守治疗15例(保守组)。所有病例均随访3个月以上,对比分析各组围手术期并发症、术后3个月头颅CT平扫、CT灌注成像参数[脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)、达峰时间(TTP)]、GOS评分、日常生活能力量表(ADL)评分。结果LPS组和VPS组均手术成功,无手术死亡病例。保守组死亡1例。术后3个月,LPS组和VPS组Evan’s指数、戴帽征高度、CBV、CBF等指标均明显优于保守组(P<0.05),但是LPS组和VPS组之间均无统计学差异(P>0.05)。LPS组并发症总发生率(12.90%,4/31)和VPS组(39.13%,9/23)明显高于保守组(0%;P<0.05),但是LPS组明显低于VPS组(P<0.05)。术后3个月,LPS组和VPS组GOS评分及ADL评分均显著高于保守组(P<0.05),但是LPS组和VPS组之间无统计学差异(P>0.05)。结论对于颅脑损伤继发正常压力脑积水,建议积极手术治疗,VPS和LPS均是有效的方法,而LPS并发症相对更少。

Objective To explore the treatment methods of normal pressure hydrocephalus(NPH)secondary to traumatic brain injury(TBI)and to analyze their clinical effects.Methods The clinical data of 69 patients with NPH secondary to TBI who were admitted to our hospital from January 2017 to September 2019 were analyzed retrospectively.Of these patients,31 patients were treated with lumbar cistern-peritoneal shunt(LPS group),23 with ventricular-abdominal shunt(VPS group),and 15 with conservative treatment(conservative group).All the patients were followed up for more than 3 months,and the perioperative complications,the results of postoperative CT imaging,the CT perfusion imaging parameters including cerebral blood volume(CBV),cerebral blood flow(CBF),average pass Time(MTT),and time to peak(TTP),the GOS score,and the ADL score were compared among the three groups 3 months after the operation.Results The operations were successful in all the patients of both the LPS and VPS groups,and there were no patients died from the operation.One patient died in the conservative group.The Evan's index,the height of the wearing cap sign,CBV,and CBF in both the LPS and VPS groups were significantly better than those in the conservative group(P<0.05),but there was no statistical difference between the LPS and VPS groups(P>0.05).The total rate of complications in the VPS group(39.13%,9/23)was significantly higher than that(12.90%,4/31)in the LPS group(P<0.05).The total rates of complications in both the VPS and LPS groups were significantly higher than that(0%)in the conservative group(P<0.05).The GOS scores and ADL scores in both the LPS and VPS groups were significantly higher than those in the conservative group(P<0.05),but there was no statistical difference between the LPS and VPS groups(P>0.05).Conclusion The NPH secondary to TBI should be treated using the operation.Both VPS and LPS are effective methods for NPH secondary to TBI,and the LPS has fewer complications compared with the VPS.