摘要
目的评估颅骨缺损合并交通性脑积水病人一期行脑室-腹腔分流术(ventriculoperitoneal shunt,VPS)+颅骨修补术的治疗效果及预后。方法回顾性分析106例颅骨缺损合并交通性脑积水病人的临床资料,均行一期VPS+颅骨修补手术,并统计分析手术前后Barthel评分、Fugl-Meyer评分及GCS评分。结果本组术后缓解79例,部分缓解24例,无效3例。对比病人手术前与术后1个月Barthel评分、Fugl-Meyer评分及GCS评分差异均有统计学意义(P <0.05)。术后发生手术相关并发症7例:其中皮下积液3例,脑脊液鼻漏合并颅内感染1例,术区脑出血1例,硬膜外血肿2例。随访16个月,GOS评分5分18例,4分61例,3分18例,2分9例;总有效率为91.5%。结论对颅骨缺损合并交通性脑积水病人,一期联合手术疗效肯定,应加强病人病情评估及术后监测,术后出现感染或脑出血应积极外科治疗。
Objective To evaluate the therapeutic effect and prognosis of one-stage ventriculoperitoneal shunt(VPS) and cranioplasty in patients with post-operative calvarial defects with communicating hydrocephalus. Methods Clinical data of 106 patients with calvarial defectscombined with communicating hydrocephalus undergoing one-stage VPS and cranioplasty were analyzed retrospectively. Barthel scores, Fugl-Meyer scores and GCS scores were statistically analyzed and compared between preoperation and postoperation. Results Remission was achieved in 79 patients, partial remission in 24 and ineffective response in 3 after the operation. There were statistical differences in Barthel scores, Fugl-Meyer scores and GCS scores between preoperation and 1 month after the operation(all P < 0.05). Postoperative complications occurred in 7 patients, including subcutaneous effusion in 3, cerebrospinal fluid rhinorrhea with intracranial infection in 1, intracerebral hemorrhage in the operative area in 1 and epidural hematoma in 2. During a follow-up period of 1 to 6 months, according to GOS score, 5 points were seen in 18 patients, 4 in 61, 3 in 18 and 2 in 9, and the total response rate was 91.5%. Conclusions For the patients with calvarial defects combined with communicating hydrocephalus, the efficacy of one-stage combined operation is positive. Patient’s condition evaluation and postoperative monitoring should be strengthened, and postoperative infection or cerebral hemorrhage should be actively treated surgically.
作者
常洪波
高铭
曹卫东
赵虎林
程岗
郭胜利
王鹏
张剑宁
Chang Hongbo;Gao Ming;Cao Weidong;Zhao Hulin;Cheng Gang;Guo Shengli;Wang Peng;Zhang Jianning(Department of Neurosurgery,The First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Department of Pediatrics,The Seventh Medical Center of Chinese PLA General Hospital,Beijing 100010,China)
出处
《中国微侵袭神经外科杂志》
CAS
2021年第3期110-113,共4页
Chinese Journal of Minimally Invasive Neurosurgery
基金
解放军总医院第六医学中心创新培育基金(编号:CXPY201805)。
关键词
脑积水
交通性
颅骨缺损
脑室腹膜分流术
颅骨修补术
hydrocephalus
communicating
calvarial defects
ventriculoperitoneal shunt
cranioplasty
