摘要
目的 分析比较颅骨大骨瓣缺损早/晚期行钛网数字化成形修补术的有效性、安全性及对预后的影响.方法 选取2012年1月至2013年12月颅脑创伤或行脑出血行去大骨瓣减压术112例,76例在去大骨瓣减压术后38.9（32-52）d行钛网数字化成形修补术（早期修补组）;36例在去大骨瓣减压术后114.2（90-153）d进行修补（晚期修补组）.分析比较2组手术耗时、皮瓣游离时间、手术失血量、并发症,以及术后患者的日常生活活动能力（ADL）评分、Fugl-Meyery评分、神经功能缺损评分、认知功能恢复.结果 早期修补组与晚期修补组的手术时间分别为（92.33±13.71） min与（141.67±18.12）min;皮瓣游离时间为（13.29±3.43） min与（38.56±7.35） min;手术出血量分别为（352.36±21.83） ml与（523.53±32.51）ml,差异具有统计学意义（P＜0.01）.早期修补组的硬膜下积液率及皮瓣游离过程中硬膜破裂率明显少于晚期修补组,差异具有统计学意义（P＜0.01）.早期修补组ADL及Fugl-Meyery评分均较晚期修补组明显提高,差异具有统计学意义（P＜0.05或P＜0.01）;而神经功能缺损评分明显降低,差异具有统计学意义（P＜0.05）.蒙特利尔认知评估量表提示早期修补组认知功能恢复明显优于晚期修补组,差异具有统计学意义（P＜0.05）.结论 颅骨大骨瓣缺损早期行钛网数字化成形修补术优于晚期,早期颅骨修补利于软组织分离,减少出血,改善预后.钛网数字化成形技术可确保修复钛网与颅骨缺损部位精确合体,显著缩短手术时间,减少手术风险;钛网数字化成形早期颅骨修补术值得临床推广.
Objective To analyze and compare the effect,safety and prognosis of early and late digital shaping titanium mesh cranioplasty after skull bone flap defect.Methods One hundred and twelve patients with craniocerebral trauma or cerebral hemorrhage treated by decompressive craniectomy from Jan.2012 to Dec.2013 were included.Seventy-six cases were treated by digital shaping titanium mesh cranioplasty after average 38.9 （32- 52） d after decompressive craniectomy （early repair group）,and thirty-six cases were given operation after 114.2 （90-153） d （advanced repair group）.The operation time,skin flap free time,operation blood loss,complications,postoperative patients＆#39; activities of daily living （ADL） score,Fugl-Meyery score,neurological deficit score and the recovery of cognitive function of the two groups were compared and analyzed.Results Operation time of early repair group and late repair group were （92.33±13.71） min and （141.67±18.12） min,flap free time were （13.29± 3.43） min and （38.56±7.35） min,and operation bleeding volume were （352.36 ± 21.83） ml and （523.53±32.51） ml （P〈0.01）.The subdural effusion rate and the dural rupture rate during skin flap free of early repair group was significantly less than that of late repair group （P〈0.01）.ADL and Fugl-Meyery scores in early repair group were increased obviously compared with advanced repair group with significant difference （P〈0.05 or P〈0.01）,while the neurological deficit score decreased significantly （P〈0.05）.The Montreal cognitive assessment suggested that cognitive function in early repair group was better than that of the late repair group with significant difference （P〈0.05）.Conclusions Early digital shaping titanium mesh cranioplasty after skull bone flap defect is better than late treatment with easy soft tissue separation,reduced bleeding and improved prognosis.Digital titanium mesh shaping can ensure precise fit with skull defect,significantly shorten the operation time
出处
《国际生物医学工程杂志》
CAS
2015年第1期48-51,I0007,共5页
International Journal of Biomedical Engineering
关键词
钛网数字化成形
早期颅骨修补术
认知功能
日常生活活动能力
并发症
Digital titanium mesh shaping
Early cranioplasty
Cognitive function
Activities of daily living
Complications
