三维打印颅内压平衡装置预防幕上去骨瓣减压术后并发症的临床效果分析

Analysis of the clinical effects of a three dimensional-printed intracranial pressure balancing device in preventing complications after suboccipital craniectomy

目的探讨三维打印颅内压平衡装置预防幕上去骨瓣减压术(DC)术后并发症的临床效果。方法本研究为回顾性队列研究。回顾性分析2020年9月至2023年9月首都医科大学附属北京朝阳医院神经外科收治的35例DC术后患者的临床和影像学资料。男性24例,女性11例,年龄(48.7±14.9)岁(范围:17~74岁)。其中19例患者DC术后应用颅内压平衡装置固定于骨窗缺损处,纳入试验组。该装置采用医用二氯乙酸树脂材料作为骨架,通过患者术后头部CT检查数据进行三维打印制作而成。16例患者DC术后不放置颅内压平衡装置,作为对照组,其他治疗及操作同试验组。收集患者DC术后并发症及行颅骨修补术前残留并发症情况,采用改良Rankin量表(mRS)评估患者颅骨修补术后临床功能情况。数据比较采用χ^(2)检验或Fisher确切概率法。结果35例患者中,30例(85.7%)发生DC术后并发症,其中硬膜下积液27例(77.1%),发生于术后(8.8±6.5)d(范围:1~23 d);脑组织膨出15例(42.9%),发生于术后[M(IQR)]7.0(21.0)d(范围:2~106 d);脑积水6例(17.1%),发生于术后34.5(111.0)d(范围:22~136 d);脑梗死3例;脑出血1例。试验组与对照组的DC术后并发症发生情况无差异(P值均>0.05);患者颅骨修补前残留DC术后并发症的情况有差异,试验组硬膜下积液的患者少于对照组(0/19比5/16,P=0.013)。两组患者颅骨修补术后mRS评分无差异(χ^(2)=0.923,P>0.05)。结论颅内压平衡装置对骨瓣减压术后硬膜下积液具有防治效果,但并未明显改善DC术后患者预后,需进一步探索研究。

Objective To explore the clinical effects of a 3D-printed intracranial pressure balancing device in preventing complications after suboccipital craniectomy(DC).Methods This study is a retrospective cohort analysis.The clinical data of 35 patients who underwent DC at Department of Neurosurgery,Beijing Chaoyang Hospital,Capital Medical University,from September 2020 to September 2023 were reviewed.The cohort included 24 males and 11 females,with an age of(48.7±14.9)years(range:17 to 74 years).Nineteen patients(experimental group)received the intracranial pressure balancing device fixed to the bone defect site post-DC.This device was made using medical-grade dicyanamide resin and was three dimensional printed based on postoperative CT scans of the patients.The remaining 16 patients(control group)did not receive the intracranial pressure balancing device,while other treatments and procedures were consistent with the experimental group.Data were compared using theχ^(2) test or Fisher′s exact probability method.Results Out of the 35 patients,30 cases(85.7%)experienced complications following DC.Specific complications included cerebral infarction in 3 cases(8.6%),intracerebral hemorrhage in 1 case(2.9%),subdural effusion in 27 cases(77.1%)with a median onset of(8.8±6.5)days(range:1 to 23 days),brain tissue protrusion in 15 cases(42.9%)with a median onset of(M(IQR))7.0(21.0)days(range:2 to 106 days),and hydrocephalus in 6 cases(17.14%)with a median onset of 34.5(111.0)days(range:22 to 136 days).There were no significant differences in the occurrence of complications(all P>0.05).However,there was a significant reduction in the incidence of subdural effusion in the experimental group prior to cranioplasty(P=0.013).No significant differences were noted in mRS scores between the two groups after cranioplasty(P>0.05).Conclusion sThe intracranial pressure balancing device has the effect of prevention and treatment of subdural effusion.However,it did not significantly improve patient prognosis post-DC,warranting further investigation.