带肌蒂颅脑修复成形术联合NGF经鼻脑靶向治疗颅脑损伤临床观察

Clinical observation of muscle-pedicled craniocerebral repair combined with NGF naso-cerebral targeted therapy craniocerebral injury

目的探讨带肌蒂颅脑修复成形术联合神经生长因子(NGF)经鼻脑靶向治疗对颅脑损伤患者的脑血流变化及神经功能恢复的影响。方法颅脑损伤术后颅骨缺损患者116例,随机分为对照组56例和观察组60例,2组均行带肌蒂颅脑修复成形手术治疗,观察组在对照组的基础上给予NGF经鼻腔滴注,对损伤脑组织靶向神经营养修复治疗。应用CT脑灌注及FIM评分、GOS评分来评估治疗后2组脑血流循环及神经功能的改善情况。结果治疗后2组缺损侧皮质区CBF(71.90±12.38)、CBV(8.65±1.73)分别较治疗前CBF(60.37±13.03)、CBV(6.86±1.82)显著增加(P<0.01);两侧基底节区和丘脑相关区域治疗后较治疗前脑血流灌注相关数值均有所增加,但差异无统计学意义(P>0.05);治疗后3个月观察组FIM评分、GOS评分明均显高于对照组(P<0.01)。结论带肌蒂颅脑修复成形术联合NGF经鼻脑靶向治疗颅脑损伤,恢复了颅腔内环境和颅内压力的稳态,显著增加了缺损侧的脑血流灌注,促进了神经功能的恢复。

Objective To investigate the effect of cranioplasty with muscle pedicle combined with nerve growth factor(NGF)targeting therapy on cerebral blood flow and nerve function recovery in patients with craniocerebral injury.Methods One hundred and sixteen patients with skull defect after craniocerebral injury were randomly divided into control group(56 cases)and observation group(60 cases).Both groups were treated by cranioplasty with muscle pedicle.The observation group was given NGF through nasal cavity infusion on the basis of the control group,and targeted neurotrophic repair treatment was applied to the injured brain tissue.CT cerebral perfusion and GOS scoreand FIM score were used to evaluate the improvement of cerebral blood circulation and neurological function in the two groups after treatment.Results After treatment,CBF(71.90±12.38)and CBV(8.65±1.73)in the cortical area of the defect side of the two groups were significantly higher than those before treatment(60.37±13.03)and CBV(6.86±1.82),respectively(P<0.01).After treatment,both basal ganglia region and thalamus related region have increased relative values of cerebral blood perfusion compared with that before treatment,but there is no significant difference(P>0.05).The FIM score and GOS score of the observation group were significantly higher than that of the control group 3 months after treatment(P<0.01).Conclusion Cranioplasty with muscle pedicle combined with NGF nasal brain targeting therapy for craniocerebral injury has restored the homeostasis of intracranial environment and intracranial pressure,significantly increased cerebral blood perfusion on the defect side,and promoted the recovery of nerve function.