同期颅骨修补术与脑室腹腔分流术联合治疗重症颅脑损伤颅骨缺损并脑积水的临床效果

Clinical effect of cranioplasty combined with ventriculoperitoneal shunt in the treatment of skull defect and hydrocephalus after severe craniocerebral injury at the same stage

目的探讨同期颅骨修补术与脑室腹腔分流术联合治疗重症颅脑损伤颅骨缺损合并脑积水的临床效果。方法选择2016年1月至2018年10月我院神经外科收治的200例重症颅脑损伤颅骨缺损并脑积水患者作为研究对象,依据随机数字表法将其分为对照组和观察组,每组100例。对照组分期实施颅骨修补术、脑室腹腔分流术,观察组同期实施颅骨修补术、脑室腹腔分流术,比较两组的治疗效果。结果观察组的手术用时、术后住院时间短于对照组,术中出血量少于对照组(P<0.05)。观察组的术后并发症总发生率低于对照组(P<0.05)。手术后,两组的MMSE、MoCA、KPS评分均提高,且观察组高于对照组(P<0.05)。观察组的治疗总有效率高于对照组(P<0.05)。术后3、6个月,两组的NIHSS评分均降低,且观察组低于对照组(P<0.05)。观察组的预后良好率高于对照组(P<0.05)。结论同期颅骨修补术与脑室腹腔分流术对重症颅脑损伤颅骨缺损合并脑积水的临床疗效显著,可减轻手术创伤,改善患者认知功能、身体机能及预后。

Objective To investigate the clinical effect of cranioplasty combined with ventriculoperitoneal shunt in the treatment of skull defect and hydrocephalus after severe craniocerebral injury at the same stage.Methods From January 2016 to October 2018,200 patients with skull defect and hydrocephalus after severe craniocerebral injury admitted in neurosurgery department of our hospital were selected as the study objects and divided into control group and observation group according to the random number table method,with 100 cases in each group.In the control group,cranioplasty and ventriculoperitoneal shunt were performed by stages,while in the observation group,cranioplasty and ventriculoperitoneal shunt were performed at the same stage.The therapeutic effects of the two groups were compared.Results The operative time and postoperative hospital stay of the observation group were shorter than those of the control group,and the intraoperative blood loss was less than that of the control group(P<0.05).The total incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05).After operation,the scores of MMSE,MOCA and KPS of the two groups increased,and those in the observation group were higher than the control group(P<0.05).The total effective rate of treatment of the observation group was higher than that of the control group(P<0.05).At 3 and 6 months after operation,the NIHSS score in the two groups decreased,and those in the observation group were lower than the control group(P<0.05).The good prognosis rate of the observation group was higher than that of the control group(P<0.05).Conclusion The cranioplasty combined with ventriculoperitoneal shunt in the same period in the treatment of skull defect and hydrocephalus after severe craniocerebral injury has a significant clinical effect.It can reduce the surgical trauma,improve the cognitive function,physical function and prognosis of patients.