自体阔筋膜在开颅去骨瓣减压术后迟发性头皮感染治疗中的临床应用
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摘要
目的探讨自体阔筋膜治疗开颅去骨瓣减压术后迟发性头皮感染的临床疗效。方法回顾性分析2003年2月至2014年9月南充市中心医院神经外科收治的21例开颅去骨瓣减压术后迟发性头皮感染病人的临床资料,头皮及皮下组织彻底清创,均取出人工硬脑膜,然后用自体阔筋膜修补硬脑膜。结果 21例病人感染处头皮I期愈合,术后随访12个月,无头皮感染、癫痫、脑脊液漏、皮下积液,无头皮坏死、破溃、溢液等并发症。结论开颅去骨瓣减压术后迟发性头皮感染难以保留人工硬脑膜修复皮瓣,可取出人工硬脑膜后用自体阔筋膜修补硬脑膜,临床效果好。
Objective To investigate the clinical curative effects of autologous fascia lata in treating delayed scalp infection after decompressive craniectomy.Methods The clinical data of 21 patients with delayed scalp infection after decompressive craniectomy treated in the Department of Neurosurgery,Nanchong Central Hospital from February 2003 to September 2014 were retrospectively analyzed.The scalp and subcutaneous tissues were debrided completely.The artificial endocranium was removed and repaired with autologous fascia lata.Results Infected scalp of all cases were healing by first intention.Post-surgical 12-month follow-up found no complications such as scalp infection,epilepsy,cerebrospinal fluid leakage,subcutaneous fluid,scalp necrosis,scalp ulceration and scalp discharge in any of the cases.Conclusion It is difficult to retain the artificial endocranium and repair local flap in the delayed scalp infection.The method of repairing endocranium with autologous fascia lata after removing the artificial endocranium is effective,and the outcomes are satisfying.
Objective To investigate the clinical curative effects of autologous fascia lata in treating delayed scalp infection after decompressive craniectomy.Methods The clinical data of 21 patients with delayed scalp infection after decompressive craniectomy treated in the Department of Neurosurgery,Nanchong Central Hospital from February 2003 to September 2014 were retrospectively analyzed.The scalp and subcutaneous tissues were debrided completely.The artificial endocranium was removed and repaired with autologous fascia lata.Results Infected scalp of all cases were healing by first intention.Post-surgical 12-month follow-up found no complications such as scalp infection,epilepsy,cerebrospinal fluid leakage,subcutaneous fluid,scalp necrosis,scalp ulceration and scalp discharge in any of the cases.Conclusion It is difficult to retain the artificial endocranium and repair local flap in the delayed scalp infection.The method of repairing endocranium with autologous fascia lata after removing the artificial endocranium is effective,and the outcomes are satisfying.
引文
[1] 葛信波.开颅术后迟发性头皮感染常见原因及治疗[J].中国医师进修杂志,2013,36(17):69-70.
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[5] 陈寒春,王之敏.前颅底骨折后的外伤性迟发性脑脊液鼻漏手术治疗[J].安徽医药,2016,20(11):2081-2083.
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[9] 黎开谷,王忠安,樊静,等.开颅术后头皮迟发性感染伴颅骨自溶2例[J].临床神经外科杂志,2014,11(5):385-386.
[10] 董丽,陈学英,张育敏,等.同种阔筋膜临床应用研究进展[J].中国修复重建外科杂志,2012,26(7):880-884.
[11] 查炜光,许明火,张立志.阔筋膜和转移皮瓣在颅脑组织缺损修复中的应用[J].临床耳鼻咽喉头颈外科杂志,2013,27(21):1191-1192.
[2] 徐中,刘惠祥,沈鸟松,等.颅骨修补术后皮瓣坏死与钛网外露原因分析及防治[J].中国临床神经外科杂志,2015,20(1):28-30.
[3] 曹富裕,武弋,李宗正,等.颅骨修补术后感染的相关因素分析[J].创伤外科杂志,2015,17(1):76-79.
[4] 刘占军,刘汉东.阔筋膜减张缝合硬脑膜结合早期钛网修补颅骨缺损的体会[J].中国临床神经外科杂志,2012,17(6):366-368.
[5] 陈寒春,王之敏.前颅底骨折后的外伤性迟发性脑脊液鼻漏手术治疗[J].安徽医药,2016,20(11):2081-2083.
[6] 郑树国.大腿阔筋膜修复鼻中隔穿孔39例疗效分析[J].现代诊断与治疗,2014,25(4):905-906.
[7] JANG YJ,WANG JH,SINHA V,et al.Tutoplast-processed fascia lata for dorsal augmentation in rhinoplasty[J].Otolaryngol Head Neck Surg,2007,137(1):88-92.
[8] 胡泽军,杨安强.自体阔筋膜后颅凹硬脑膜扩大修补的临床应用[J].四川医学,2011,32(9):1445-1446.
[9] 黎开谷,王忠安,樊静,等.开颅术后头皮迟发性感染伴颅骨自溶2例[J].临床神经外科杂志,2014,11(5):385-386.
[10] 董丽,陈学英,张育敏,等.同种阔筋膜临床应用研究进展[J].中国修复重建外科杂志,2012,26(7):880-884.
[11] 查炜光,许明火,张立志.阔筋膜和转移皮瓣在颅脑组织缺损修复中的应用[J].临床耳鼻咽喉头颈外科杂志,2013,27(21):1191-1192.