颅骨修补手术方式的选择
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摘要
目的 探讨颅骨修补术式的选择,降低术后并发症。方法 回顾性分析2014年1月—2018年1月本院神经外科使用数字化钛板行颅骨修补的140例额颞部颅骨缺损患者的临床资料,根据术中肽板放置位置,将患者分为颞肌下组(钛板放置在颞肌下)和颞肌外组(钛板放置在颞肌外)两组。结果 颞肌下组60例,其中术后硬膜外血肿患者6例(10%),皮下积液12例(20%),癫痫发作3例(5%),颞部皮肤凹陷0例;颞肌外组80例,其中术后硬膜外血肿0例,皮下积液5例(6%),癫痫0例,颞部皮肤凹陷10例(12.5%)。两组在发生硬膜外血肿、皮下积液上比较,颞肌外组优于颞肌下组(P<0.05);在颞部皮肤凹陷上比较,颞肌下组优于颞肌外组(P<0.05);在癫痫发作上比较,两组无统计学差异(P>0.05)。结论 颞肌下组60例,其中术后硬膜外血肿患者6例(10%),皮下积液12例(20%),癫痫发作3例(5%),颞部皮肤凹陷0例;颞肌外组80例,其中术后硬膜外血肿0例,皮下积液5例(6%),癫痫0例,颞部皮肤凹陷10例(12.5%)。两组在发生硬膜外血肿、皮下积液上比较,颞肌外组优于颞肌下组(P<0.05);在颞部皮肤凹陷上比较,颞肌下组优于颞肌外组(P<0.05);在癫痫发作上比较,两组无统计学差异(P>0.05)。
Objective To discuss the selection of surgical methods for cranioplasty and to reduce the postoperative complications.Methods The clinical data of 140 cases of patients suffered with frontotemporal skull defect those who received cranioplasty by using digital titanium plate from January 2014 to July 2018 in neurosurgery department of Yijishan hospital of Wannan Medical College were retrospectively analyzed.They were divided into sub-temporal group( the titanium plate was placed under temporalis muscle) and extra-temporal group( the titanium plate was placed outside temporalis muscle). Results There were 60 cases in the sub-temporal group,6 cases( 10%) with epidural hematoma,12 cases( 20%) with subcutaneous effusion,3 cases( 5%) with epilepsy and 0 cases with temporal skin depression.80 cases in the sub-temporal group,0 cases with epidural hematoma,5 cases( 6%) with subcutaneous effusion,0 cases with epilepsy and 10 cases( 12.5%) with temporal skin depression. The incidence of epidural hematoma and subcutaneous effusion in the extra-temporal group was better than that in the sub-temporal group( P< 0.05). In the temporal skin depression sub-temporal group was better than in the extra-temporal group( P < 0. 05). There was no significant difference in epilepsy between the two groups( P > 0. 05). Conclusions Both methods have advantages and disadvantages.Individualized surgery should be adopted according to specific patients.
Objective To discuss the selection of surgical methods for cranioplasty and to reduce the postoperative complications.Methods The clinical data of 140 cases of patients suffered with frontotemporal skull defect those who received cranioplasty by using digital titanium plate from January 2014 to July 2018 in neurosurgery department of Yijishan hospital of Wannan Medical College were retrospectively analyzed.They were divided into sub-temporal group( the titanium plate was placed under temporalis muscle) and extra-temporal group( the titanium plate was placed outside temporalis muscle). Results There were 60 cases in the sub-temporal group,6 cases( 10%) with epidural hematoma,12 cases( 20%) with subcutaneous effusion,3 cases( 5%) with epilepsy and 0 cases with temporal skin depression.80 cases in the sub-temporal group,0 cases with epidural hematoma,5 cases( 6%) with subcutaneous effusion,0 cases with epilepsy and 10 cases( 12.5%) with temporal skin depression. The incidence of epidural hematoma and subcutaneous effusion in the extra-temporal group was better than that in the sub-temporal group( P< 0.05). In the temporal skin depression sub-temporal group was better than in the extra-temporal group( P < 0. 05). There was no significant difference in epilepsy between the two groups( P > 0. 05). Conclusions Both methods have advantages and disadvantages.Individualized surgery should be adopted according to specific patients.
引文
[1]刘家胜,史锡文.外伤性迟发性硬膜外血肿的早期诊断与治疗[J].中国实用神经疾病杂志,2011,14(5):63-65.
[2]赵爱国.颅骨修补对颅脑创伤患者去骨瓣减压术后并发对侧硬膜下积液的临床意义[J].中华神经外科杂志,2014,30(3):257-259.
[3]中华医学会神经外科学分会神经创伤专业组.颅脑创伤后癫痫防治中国专家共识[J].中华神经外科杂志,2017,33(7):652-654.
[4]罗晟,何永生,陈隆益,等.数字化塑型钛网颅骨修补对颅骨缺损患者颅内压、脑血流动力学及神经功能康复的影响[J].中华神经医学杂志,2015,14(11):1128-1133.
[5]卞戈,李敏,陈岗,等.脑CT灌注对颅骨修补前后脑血流变化的评价[J].临床放射学杂志,2014,33(10):1485-1488.
[6]Yong J:C,Kang SH.Review of cranioplasty after decompressive craniectomy[J].Korean J Neurotraum,2017,13(1):9-14.
[7]侯晓峰,张春阳,孙建营,等.颅骨修补手术时机的选择与手术技巧[J].中华神经外科杂志,2011,27(8):847-849.
[8]王春晖,王君玉,李振兴,等.不同时期颅骨修补治疗颅骨缺损的疗效观察[J].第二军医大学学报,2017,38(3):335-338.
[9]Zheng F,Krischek B.Early cranioplasty:There is still much to be uncovered[J].Clin Neurol Neurosur,2016,143:162-163.
[10]张震军,张春阳,苏里,等.颅骨修补术后严重并发症的分析与处理[J].中华神经外科杂志,2011,27(12):1266-1267.
[11]Zanaty M,Chalouhi N,Starke RM,et al.Complications following cranioplasty:incidence and predictors in 348 cases[J].J Neurosur,2015,123(1):182-188.
[12]胡旭,王玉海,陈星,等.双侧颅骨修补术后癫痫发作的影响因素分析[J].中华神经外科杂志,2016,32(7):714-717.
[13]黄警锐,肖虹,程凯敏.比较标准大骨瓣减压术后行颞肌下和颞肌外两种颅骨修补术的临床疗效及特点[J].重庆医科大学学报,2011,36(9):1132-1134.
[14]Honeybul S,Ho KM.Cranioplasty:morbidity and failure[J].Brit JNeurosurg,2016,30(5):523-528.
[2]赵爱国.颅骨修补对颅脑创伤患者去骨瓣减压术后并发对侧硬膜下积液的临床意义[J].中华神经外科杂志,2014,30(3):257-259.
[3]中华医学会神经外科学分会神经创伤专业组.颅脑创伤后癫痫防治中国专家共识[J].中华神经外科杂志,2017,33(7):652-654.
[4]罗晟,何永生,陈隆益,等.数字化塑型钛网颅骨修补对颅骨缺损患者颅内压、脑血流动力学及神经功能康复的影响[J].中华神经医学杂志,2015,14(11):1128-1133.
[5]卞戈,李敏,陈岗,等.脑CT灌注对颅骨修补前后脑血流变化的评价[J].临床放射学杂志,2014,33(10):1485-1488.
[6]Yong J:C,Kang SH.Review of cranioplasty after decompressive craniectomy[J].Korean J Neurotraum,2017,13(1):9-14.
[7]侯晓峰,张春阳,孙建营,等.颅骨修补手术时机的选择与手术技巧[J].中华神经外科杂志,2011,27(8):847-849.
[8]王春晖,王君玉,李振兴,等.不同时期颅骨修补治疗颅骨缺损的疗效观察[J].第二军医大学学报,2017,38(3):335-338.
[9]Zheng F,Krischek B.Early cranioplasty:There is still much to be uncovered[J].Clin Neurol Neurosur,2016,143:162-163.
[10]张震军,张春阳,苏里,等.颅骨修补术后严重并发症的分析与处理[J].中华神经外科杂志,2011,27(12):1266-1267.
[11]Zanaty M,Chalouhi N,Starke RM,et al.Complications following cranioplasty:incidence and predictors in 348 cases[J].J Neurosur,2015,123(1):182-188.
[12]胡旭,王玉海,陈星,等.双侧颅骨修补术后癫痫发作的影响因素分析[J].中华神经外科杂志,2016,32(7):714-717.
[13]黄警锐,肖虹,程凯敏.比较标准大骨瓣减压术后行颞肌下和颞肌外两种颅骨修补术的临床疗效及特点[J].重庆医科大学学报,2011,36(9):1132-1134.
[14]Honeybul S,Ho KM.Cranioplasty:morbidity and failure[J].Brit JNeurosurg,2016,30(5):523-528.