颅脑损伤大骨瓣减压术后半球间积液与并发脑积水的相关性研究
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摘要
目的研究重度颅脑损伤患者去骨瓣减压术后出现半球间积液与并发脑积水之间是否存在关联性。方法回顾性分析黄山市人民医院21例重度颅脑损伤术后的患者,并对这些患者的相关情况(年龄、性别、受伤机制、颅外损伤情况、GCS评分、四肢肌力、及瞳孔情况、CT表现)进行总结;所有研究对象均行标准重度颅脑损伤去大骨瓣减压术治疗,定期随访6月;同时采用SPSS 18.0软件,应用Fisher确切概率法检验,P<0.05为差异有统计学意义。结果去骨瓣减压术后患者半球间积水和脑积水之间的关联性具有统计学意义(P<0.05);术后患者并发脑积水的概率为38.09%。结论重度颅脑损伤标准去大骨瓣减压术后出现半球间积液可能是预测早期脑积水发生的影像学指标。重度颅脑损伤患者发生脑积水可能与以下两个因素有关:①重度颅脑损伤的原发性损伤破坏了脑脊液循环机制;②颅内压力平衡机制的改变影响脑脊液的循环。同时通过连续观察CT片,发现很多患者半球间积水有向脑积水演变的过程,笔者推断重度颅脑损伤去骨瓣减压术后出现脑积水可分为脑内压力变化组织移位和蛛网膜颗粒的功能降低、消失两个阶段。所以我们可以根据是否发生半球间积液来指导临床:如患者早期即出现半球间积液,那么我们可进行积极治疗预防脑积水的发生,改善患者的预后。
Objective To study the correlation between interhemispheric hygroma and hydrocephalus after decompressive craniectomy( DC) in patients with severe craniocerebral injury. Methods The clinical data( age,gender,injury mechanism,extracranial damage,Glasgow Coma Scale,limb muscle strength,the pupil,CT manifestations) of 21 cases of severe craniocerebral injury after decompressive craniotomy in our hospital were analyzed retrospectively. The regular follow-up was 6 months. The correlation between interhemispheric hygroma and hydrocephalus were analyzed by using Fisher's exact probability method test and taking P < 0. 05 for the relevance was statistically significant. Results There was some connection between interhemispheric hygroma and hydrocephalus after decompressive craniectomy in severe craniocerebral injury( P = 0. 035); The probability of postoperative patients complicated with hydrocephalus was 38. 09%. Conclusion Interhemispheric hygroma may be one of early iconography sign of the occurrence of hydrocephalus in early phase in the patients receiving standard large trauma craniotomy. The possible causes of hydrocephalus after severe traumatic head injury is unknown,this may be related to the following two factors: primary injury of patients with severe craniocerebral injury has destroyed the cerebrospinal fluid circulation mechanism; the change of intracranial pressure balance mechanism has affected the cerebrospinal fluid circulation. At the same time,the continuous observation of CT slices shows a process of evolution from interhemispheric hygroma to hydrocephalus in many patients. There are two stages: pressure changes in the brain lead to tissue displacement and arachnoid granulations functional decrease or disappear after decompressive craniectomy in severe craniocerebral injury. So the interhemispheric hygroma can be guidance in clinic: if patients in the early stage turn up interhemispheric hygroma,we can be aggressive treatment to prevent the occurrence of hydrocephalus,and then improve the prognosis of patients.
Objective To study the correlation between interhemispheric hygroma and hydrocephalus after decompressive craniectomy( DC) in patients with severe craniocerebral injury. Methods The clinical data( age,gender,injury mechanism,extracranial damage,Glasgow Coma Scale,limb muscle strength,the pupil,CT manifestations) of 21 cases of severe craniocerebral injury after decompressive craniotomy in our hospital were analyzed retrospectively. The regular follow-up was 6 months. The correlation between interhemispheric hygroma and hydrocephalus were analyzed by using Fisher's exact probability method test and taking P < 0. 05 for the relevance was statistically significant. Results There was some connection between interhemispheric hygroma and hydrocephalus after decompressive craniectomy in severe craniocerebral injury( P = 0. 035); The probability of postoperative patients complicated with hydrocephalus was 38. 09%. Conclusion Interhemispheric hygroma may be one of early iconography sign of the occurrence of hydrocephalus in early phase in the patients receiving standard large trauma craniotomy. The possible causes of hydrocephalus after severe traumatic head injury is unknown,this may be related to the following two factors: primary injury of patients with severe craniocerebral injury has destroyed the cerebrospinal fluid circulation mechanism; the change of intracranial pressure balance mechanism has affected the cerebrospinal fluid circulation. At the same time,the continuous observation of CT slices shows a process of evolution from interhemispheric hygroma to hydrocephalus in many patients. There are two stages: pressure changes in the brain lead to tissue displacement and arachnoid granulations functional decrease or disappear after decompressive craniectomy in severe craniocerebral injury. So the interhemispheric hygroma can be guidance in clinic: if patients in the early stage turn up interhemispheric hygroma,we can be aggressive treatment to prevent the occurrence of hydrocephalus,and then improve the prognosis of patients.
引文
[1]龙清河.标准去大骨瓣减压术与传统法骨瓣减压术治疗重型颅脑损伤的疗效对比[J].中外医疗,2011,30(24):31-32.
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[3]陈茂送,王洪财,严斌.标准大骨瓣减压术对重型颅脑损伤患者颅内压及预后的影响[J].中国现代医生,2014,52(1):16-19.
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[6]黄强,戴伟民,揭园庆,等.重型颅脑损伤大骨瓣开颅减压术后的远期疗效分析[J].中国微侵袭神经外科杂志,2006,11(9):390-392.
[7]董平,阿木吉尔图.颅脑外伤去骨瓣减压术后并发症预防[J].中国实用神经疾病杂志,2012,15(15):73-74.
[8]张毅,柏鲁宁,柯尊华,等.重型颅脑损伤患者术后脑积水形成相关因素分析[J].中国神经精神疾病杂志,2013,39(9):519-522.
[9]Choi I,Park HK,Chang JC,et al.Clini-cal factors for the development of posttraumatic hydrocepha-lus after decompressive craniectomy[J].J Korean Neurosurg Soc,2008,43(5):227-231.
[10]Licata C,Cristofori L,Gambin R,et al.Post-traumatic hydrocephalus[J].J Neurosurg Sci,2001,45(3):141-149.
[11]张晓峰,漆松涛,零达尚,等.颅脑损伤去骨瓣减压术后慢性脑积水[J].临床神经外科杂志,2012,9(4):227-229.
[12]Denes Z,Barsi P,Szel I,et al.Complication during postacute rehabilitation:patients with posttraumatic hydrocephalus[J].Int J Rehabil Res,2011,34(3):222.
[13]Waziri A,Fusco D,Mayer SA,et al.Postoperative hydrocephalus in patients undergoing decompressive hemicraniectomy for ischemic or hemorrhagic stroke[J].Neurosurgery,2007,61(3):489-494.
[14]De Boni P,Sturiale CL,Anile C,et al.Decompressive craniectomy,interhemispheric hygroma andhydrocephalus:A timeline of events?[J].Clin Neurol Neurosurg,2013,115(8):1308-1312.
[15]宋平,蔡强,杜浩,等.慢性外伤性脑积水的外科治疗(附36例报告)[J].中国临床神经外科杂志,2011,16(12):725-727.
[2]朱旭,李俊彦.开颅术后脑积水原因及其治疗[J].中国现代医学杂志,2011,13(21):248-250.
[3]陈茂送,王洪财,严斌.标准大骨瓣减压术对重型颅脑损伤患者颅内压及预后的影响[J].中国现代医生,2014,52(1):16-19.
[4]韦立煌.标准大骨瓣减压治疗重型额颞部脑挫裂伤疗效观察[J].中国实用神经疾病杂志,2009,12(6):12-18.
[5]黄欣,金晶,黄红光.去骨瓣减压术并发症分析[J].中华创伤杂志,2011,27(5):403-405.
[6]黄强,戴伟民,揭园庆,等.重型颅脑损伤大骨瓣开颅减压术后的远期疗效分析[J].中国微侵袭神经外科杂志,2006,11(9):390-392.
[7]董平,阿木吉尔图.颅脑外伤去骨瓣减压术后并发症预防[J].中国实用神经疾病杂志,2012,15(15):73-74.
[8]张毅,柏鲁宁,柯尊华,等.重型颅脑损伤患者术后脑积水形成相关因素分析[J].中国神经精神疾病杂志,2013,39(9):519-522.
[9]Choi I,Park HK,Chang JC,et al.Clini-cal factors for the development of posttraumatic hydrocepha-lus after decompressive craniectomy[J].J Korean Neurosurg Soc,2008,43(5):227-231.
[10]Licata C,Cristofori L,Gambin R,et al.Post-traumatic hydrocephalus[J].J Neurosurg Sci,2001,45(3):141-149.
[11]张晓峰,漆松涛,零达尚,等.颅脑损伤去骨瓣减压术后慢性脑积水[J].临床神经外科杂志,2012,9(4):227-229.
[12]Denes Z,Barsi P,Szel I,et al.Complication during postacute rehabilitation:patients with posttraumatic hydrocephalus[J].Int J Rehabil Res,2011,34(3):222.
[13]Waziri A,Fusco D,Mayer SA,et al.Postoperative hydrocephalus in patients undergoing decompressive hemicraniectomy for ischemic or hemorrhagic stroke[J].Neurosurgery,2007,61(3):489-494.
[14]De Boni P,Sturiale CL,Anile C,et al.Decompressive craniectomy,interhemispheric hygroma andhydrocephalus:A timeline of events?[J].Clin Neurol Neurosurg,2013,115(8):1308-1312.
[15]宋平,蔡强,杜浩,等.慢性外伤性脑积水的外科治疗(附36例报告)[J].中国临床神经外科杂志,2011,16(12):725-727.