脑室-腹腔分流术联合同期颅骨修补术在外伤性脑积水合并颅骨缺损患者中的应用效果

Application effect of ventriculo-peritoneal shunt combined with simultaneous skull repair in patients with traumatic hydrocephalus complicated with skull defect

目的探讨脑室-腹腔分流术(V-P)联合同期颅骨修补术在外伤性脑积水(PTH)合并颅骨缺损患者中的应用效果。方法选取2019年7月至2021年6月萍乡市人民医院收治的84例PTH合并颅骨缺损患者作为研究对象进行前瞻性研究,采用随机数字表法将其分为分期组(42例)与同期组(42例)。分期组患者采用V-P分流术治疗后3~6个月行颅骨修补术治疗,同期组患者采用V-P分流术联合同期颅骨修补术治疗。比较两组患者的手术效果、神经功能、日常活动能力、预后及并发症。结果同期组患者的治疗总有效率为90.48%,高于分期组的71.43%,差异有统计学意义(P<0.05);同期组患者术后的美国国立卫生研究院卒中量表(NIHSS)评分[(12.57±2.86)分]低于分期组[(15.39±3.10)分],日常生活活动能力(ADL)评分[(65.49±17.14)分]、格拉斯哥预后量表(GOS)评分[(3.54±0.71)分]高于分期组[(54.73±18.33)分、(2.76±0.79)分],差异均有统计学意义(P<0.05)。同期组患者的并发症总发生率为9.52%,低于分期组的26.19%,差异有统计学意义(P<0.05)。结论采用V-P分流术联合同期颅骨修补术治疗PTH合并颅骨缺损患者的效果良好,可改善患者的神经功能及日常生活活动能力,减少并发症,改善预后,临床应用安全性高。

Objective To investigate the application effect of ventriculo-peritoneal shunt(V-P)combined with simultaneous skull repair in patients with traumatic hydrocephalus(PTH)complicated with skull defect.Methods From July 2019 to June 2021,84 patients with PTH combined with skull defects admitted to Pingxiang People's Hospital were selected as the subjects for prospective study.They were divided into the staging group(42 cases)and the same period group(42 cases)according to random number table method.The patients in the stage group were treated with V-P shunt and skull repair 3-6 months after treatment.The patients in the same period group were treated with V-P shunt combined with skull repair at the same time.The surgical effect,neurological function,daily activity ability,prognosis and complications were compared between the two groups.Results The total effective rate of the patients in the same period group(90.48%)was higher than that in the stage group(71.43%),the difference was statistically significant(P<0.05).The score of National Institutes of Health stroke scale(NIHSS)([12.57±2.86]points)in the same period group was lower than that in the staging group([15.39±3.10]points),the score of activities of daily living(ADL)([65.49±17.14]points)and the score of Glasgow outcome scale(GOS)([3.54±0.71]points)in the same period group were higher than those in the staging group([54.73±18.33]points and[2.76±0.79]points),the differences were statistically significant(P<0.05).The total incidence of complications in the same period group(9.52%)was lower than that in the stage group(26.19%),the difference was statistically significant(P<0.05).Conclusion V-P shunt combined with simultaneous skull repair is effective in the treatment of PTH patients with skull defect.It can improve the neurological function and activities of daily living,reduce complications and improve the prognosis.It has high safety in clinical application.