摘要
目的研究设计一种改良颅骨修补术并探讨其临床效果,以期减少并发症发生。方法对2012年8月-2014年3月手术治疗的颅脑外伤或高血压脑出血患者68例随机分为两组,A组3 2例采用标准去骨瓣减压术及颞肌下颅骨修补术;B组36例在去骨瓣减压术中于颞肌下放置数枚小骨片作为标志点,颅骨修补时设计颞肌瓣及附着点重建颞肌。两组患者性别、年龄、手术侧别、致伤原因、伤后至减压术时间及术后至颅骨修补术时间比较,差异均无统计学意义（P〉0.05）,有可比性。比较两组术后并发症发生率。结果术后两组患者切口均Ⅰ期愈合。两组患者均获随访,随访时间6~16个月,平均12个月。A组患者并发症包括头颅外观不对称4例（12.50%）,颞肌萎缩12例（37.50%）、颞部疼痛及咀嚼不适感6例（18.75%）、癫痫2例（6.25%）、脑脊液漏9例（28.13%）、脑挫裂伤1例（3.13%）及脑出血1例（3.13%）;B组仅2例（5.56%）发生颞肌萎缩,无其他相关并发症发生。两组患者并发症发生率比较,差异均有统计学意义（P〈0.05）。其余未发生并发症患者随访外形对称,功能良好。结论在去骨瓣减压术中设置骨片标志点及在颅骨修补术中行颞肌重建的改良术式明显减少了并发症的发生,是一种有效手术方式。
Objective To study and design a modified cranioplasty, and to explore the effectiveness so as to reduce the incidence rate of operative complications. Methods A total of 68 patients with craniocerebral trauma or hypertensive cerebral hemorrhage between August 2012 and March 2014 were selected and randomly divided into2 groups. The standard decompress craniectomy and under-temporal cranioplasty were performed in 32 cases（group A）,and several small bone chips were placed under-tempus during decompress craniectomy and then the shape of temporal muscle was designed and the temporal muscle was reconstructed at the attachment sites during cranioplasty in 36 cases（group B）. No significant difference was found in gender, age, side of operation, cause of injury, time between injury and decompress craniectomy, and time between postoperation and cranioplasty between 2 groups（P〉0.05）. Then the postoperative complications were compared between the 2 groups. Results Primary healing of incision was obtained in all patients. The patients were followed up 12 months on average（range, 6-16 months） in 2 groups. The follow complications occurred in group A： 4 cases of asymmetric appearance（12.50%）, 12 cases of temporal muscle atrophy（37.50%）, 6 cases of temporal pain and masticatory atonia（18.75%）, 2 cases of epilepsy（6.25%）, 9 cases of leakage of cerebrospinal fluid（28.13%）, 1 case of cerebral contusion and laceration（3.13%）, and 1 case of cerebral hemorrhage（3.13%）; temporal muscle atrophy was observed in 2 cases（5.56%） and the rate of complication was significantly lower than that in group A（P〈0.05）. The symmetrical appearance of the skull and good function were achieved in the other patients having no complication. Conclusion New technique of setting bone chip markers during decompress craniectomy and reconstructing temporal muscle during cranioplasty can reduce the incidence of complications and thus it is an effective surgical procedure.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第7期822-825,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
去骨瓣减压术
骨片标志点
颅骨修补术
颞肌重建
Decompress craniectomy
Bone chip marker
Cranioplasty
Temporal muscle reconstruction
