早期颅骨修补联合脑室腹腔分流术治疗脑外伤去骨瓣减压术后脑积水的效果观察

Effect of early cranioplasty combined with ventriculoperitoneal shunt on hydrocephalus after decompressive craniectomy for traumatic brain injury

目的探讨早期颅骨修补联合脑室腹腔分流术治疗脑外伤去骨瓣减压术后脑积水的价值。方法抽取2017年7月至2021年4月周口市中心医院收治的脑外伤去骨瓣减压术后脑积水患者86例,运用随机数字表法分为A组与B组,每组43例。A组采用早期颅骨修补联合脑室腹腔分流术,在2个月内同期进行颅骨修补术和脑室腹腔分流术;B组在2个月内采用脑室腹腔分流术,再于2~3个月后实施颅骨修补术。比较两组临床治疗效果、美国国立卫生研究院脑卒中量表(NIHSS)评分、格拉斯哥预后评分法(GOS)评分、格拉斯哥昏迷评分法(GCS)评分、Fugl-Meyer运动功能测评法(FMA)评分、日常生活活动能力量表(ADL)评分及并发症发生率。结果A组总有效率(90.70%,39/43)高于B组(74.42%,32/43),P<0.05。术后3个月,A组GOS、GCS评分及FMA、ADL评分均高于B组(P均<0.05),NIHSS评分低于B组(P<0.05)。A组并发症发生率(13.95%,6/43)与B组(18.60%,8/43)比较差异未见统计学意义(P>0.05)。结论早期颅骨修补联合脑室腹腔分流术治疗脑外伤去骨瓣减压术后脑积水,可提高患者的临床治疗效果,加快其术后神经功能、意识状态和机体功能恢复,利于提高患者的生活自理能力并改善预后。

Objective To investigate the value of early cranioplasty combined with ventriculoperitoneal shunt in the treatment of hydrocephalus after decompressive craniectomy for traumatic brain injury.Methods Eighty-six patients with hydrocephalus after decompressive craniectomy for traumatic brain injury admitted to Zhoukou Central Hospital from July 2017 to April 2021 were selected.And they were divided into group A and group B by random number table method,with 43 cases in each group.In the group A,early cranioplasty combined with ventriculoperitoneal shunt was performed,and the cranioplasty and ventriculoperitoneal shunt were performed simultaneously within 2 months.In the group B,ventriculoperitoneal shunt was performed within 2 months,and cranioplasty was performed 2 to 3 months later.The clinical treatment effect,the National Institutes of Health Stroke Scale(NIHSS)score,Glasgow outcome scale(GOS)score,Glasgow coma scale(GCS)score,Fugl Meyer motor function assessment(FMA)score,activity of daily living scale(ADL)score and complication rate of the two groups were compared.Results The total effective rate of the group A was 90.70%(39/43),higher than the 74.42%(32/43)of the group B(P<0.05).Three months after operation,the scores of GOS,GCS,FMA and ADL in the group A were higher than those in the group B(all P<0.05),while the scores of NIHSS in the group A were lower than those in the group B(P<0.05).There was no significant difference in the incidence of complications between the group A(13.95%,6/43)and the group B(18.60%,8/43),P>0.05.Conclusions Early cranioplasty combined with ventriculoperitoneal shunt in the treatment of hydrocephalus after decompressive craniotomy can improve the clinical effect,accelerate the recovery of neurological function,state of consciousness and body function after operation,which is conducive to improving the ability of self-care and improving the prognosis.