早期脑室-腹腔分流术同期联合颅骨修补术治疗脑外伤伴脑积水的临床效果研究

Study on clinical effect of early ventriculoperitoneal shunt combined with cranioplasty in the treatment of brain injury with hydrocephalus

目的探讨早期脑室-腹腔分流术同期联合颅骨修补术治疗脑外伤伴脑积水的应用价值及效果。方法116例脑外伤伴脑积水患者,所有患者均接受脑室-腹腔分流术联合颅骨修补术治疗,根据施术时间不同分为对照组与观察组,各58例。对照组在脑室-腹腔分流术后2~3个月再接受颅骨修补术治疗,观察组同时期接受早期脑室-腹腔分流术与颅骨修补术治疗。对比治疗前后两组各项评分[日常生活能力量表(ADL)、格拉斯哥昏迷评分(GCS)、格拉斯哥预后评分(GOS)、Fugl-Meyer运动功能评分法(FMA)]、临床疗效、并发症(硬膜下积液、脑水肿、感染)发生率、预后情况(植物生存、重度残疾、轻度残疾、恢复良好)。结果治疗后,观察组GOS、GCS、FMA、ADL评分分别为(4.25±0.56)、(15.24±2.51)、(77.65±17.24)、(76.25±16.54)分,对照组分别为(3.21±0.54)、(11.24±2.11)、(63.42±15.74)、(54.54±13.69)分,两组GOS、GCS、FMA、ADL评分均较治疗前升高,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组治疗总有效率93.10%高于对照组的68.97%,差异有统计学意义(P<0.05)。观察组并发症发生率13.79%低于对照组的36.21%,差异有统计学意义(P<0.05)。观察组植物生存率6.90%明显低于对照组的36.21%,恢复良好率53.45%明显高于对照组的22.41%,差异均有统计学意义(P<0.05)。结论早期脑室-腹腔分流术同期联合颅骨修补术对脑外伤伴脑积水的效果满意,具有临床应用价值。

Objective To discuss the value and effect of early ventriculoperitoneal shunt combined with cranioplasty in the treatment of brain injury with hydrocephalus.Methods A total of 116 patients with brain injury and hydrocephalus were treated by ventriculoperitoneal shunt combined with cranioplasty.They were divided into control group and observation group by different surgery time,with 58 cases in each group.The control group received The control group received cranioplasty 2-3 months after ventriculoperitoneal shunt,and the observation group received early ventriculoperitoneal shunt and cranioplasty at the same time.The scores[activities of daily living(ADL),Glasgow coma scale(GCS)score,Glasgow outcome scale(GOS)score,FuglMeyer motor assessment scale(FMA)]before and after treatment,clinical efficacy,occurrence of complications(subdural effusion,brain edema,infection),prognosis status(vegetative state,severe disability,mild disability,recovery well)were compared between the two groups.Results After treatment,GOS,GCS,FMA and ADL score of the observation group were(4.25±0.56),(15.24±2.51),(77.65±17.24)and(76.25±16.54)points,which were(3.21±0.54),(11.24±2.11),(63.42±15.74)and(54.54±13.69)points of the control group.GOS,GCS,FMA and ADL score of the two groups were higher than those before treatment,and the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).The total effective rate of treatment 93.10%of the observation group was higher than that of the control group 68.97%,and the difference was statistically significant(P<0.05).The incidence of complications 13.79%of the observation group was lower than that of the control group 36.21%,and the difference was statistically significant(P<0.05).The vegetative state rate 6.90%of the observation group was obviously lower than that of the control group 36.21%,excellentgood recovery rate 53.45%was obviously higher than that of the control group 22.41%,and the difference was statistically significant(P<0.05).Conclusion Early ventriculoperitoneal shunt combined with cranioplasty shows satisfactory effect for brain injury with hydrocephalus,and it contains clinical value.