中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2015年
9期
918-922
,共5页
曹轲%李宗正%刘玉飞%武弋%段兴浩%杨振兴%黄德俊%万定%田立庄
曹軻%李宗正%劉玉飛%武弋%段興浩%楊振興%黃德俊%萬定%田立莊
조가%리종정%류옥비%무익%단흥호%양진흥%황덕준%만정%전립장
颅骨%感染%手术后并发症%成像,三维%钛
顱骨%感染%手術後併髮癥%成像,三維%鈦
로골%감염%수술후병발증%성상,삼유%태
Skull%Infection%Postoperative complication%Imaging,three-dimensional%Ttanium
目的 探讨自体冰冻颅骨修补与三维CT成型钛网修补两种颅骨修补方案的临床效果差异及其原因.方法 对2008年1月至2010年12月216例因颅脑伤行开颅去骨瓣减压术后行自体冰冻颅骨修补的患者与同期139例行三维成型钛网修补的患者进行多中心对照研究,比较两方案术中出血量、手术持续时间、术后相关并发症的差异,以及不同时间窗修补术后术区近期(术后1个月内)及远期(术后1个月～3年)感染的差异.结果 两种修补方案的术中平均出血量(t=10.205,P =0.000)、平均手术时间(t=13.957,P=0.000),术后术区不适(x2=7.565,P=0.006)、惧冷热(x2=167.389,P=0.000)、怕震动(x2=146.654,P=0.000)等差异有统计学意义;而两方案术后出现继发性癫痫(P=0.563)、术区凹陷变形(P=0.304)的差异无统计学意义;自体骨早期修补组患者与钛网组全部患者相比,两方案术后整体感染率差异无统计学意义(x2=0.007,P=0.931),但两方案的近期感染率(x2=3.860,P=0.049)及远期感染率(x2=3.962,P=0.047)的差异有统计学意义.结论 控制自体骨组方案修补时间窗位在去骨瓣术后1～3个月内,临床效果较钛网修补的方案好,尤其在降低术后远期感染方面有明显优势.
目的 探討自體冰凍顱骨脩補與三維CT成型鈦網脩補兩種顱骨脩補方案的臨床效果差異及其原因.方法 對2008年1月至2010年12月216例因顱腦傷行開顱去骨瓣減壓術後行自體冰凍顱骨脩補的患者與同期139例行三維成型鈦網脩補的患者進行多中心對照研究,比較兩方案術中齣血量、手術持續時間、術後相關併髮癥的差異,以及不同時間窗脩補術後術區近期(術後1箇月內)及遠期(術後1箇月～3年)感染的差異.結果 兩種脩補方案的術中平均齣血量(t=10.205,P =0.000)、平均手術時間(t=13.957,P=0.000),術後術區不適(x2=7.565,P=0.006)、懼冷熱(x2=167.389,P=0.000)、怕震動(x2=146.654,P=0.000)等差異有統計學意義;而兩方案術後齣現繼髮性癲癇(P=0.563)、術區凹陷變形(P=0.304)的差異無統計學意義;自體骨早期脩補組患者與鈦網組全部患者相比,兩方案術後整體感染率差異無統計學意義(x2=0.007,P=0.931),但兩方案的近期感染率(x2=3.860,P=0.049)及遠期感染率(x2=3.962,P=0.047)的差異有統計學意義.結論 控製自體骨組方案脩補時間窗位在去骨瓣術後1～3箇月內,臨床效果較鈦網脩補的方案好,尤其在降低術後遠期感染方麵有明顯優勢.
목적 탐토자체빙동로골수보여삼유CT성형태망수보량충로골수보방안적림상효과차이급기원인.방법 대2008년1월지2010년12월216례인로뇌상행개로거골판감압술후행자체빙동로골수보적환자여동기139례행삼유성형태망수보적환자진행다중심대조연구,비교량방안술중출혈량、수술지속시간、술후상관병발증적차이,이급불동시간창수보술후술구근기(술후1개월내)급원기(술후1개월～3년)감염적차이.결과 량충수보방안적술중평균출혈량(t=10.205,P =0.000)、평균수술시간(t=13.957,P=0.000),술후술구불괄(x2=7.565,P=0.006)、구랭열(x2=167.389,P=0.000)、파진동(x2=146.654,P=0.000)등차이유통계학의의;이량방안술후출현계발성전간(P=0.563)、술구요함변형(P=0.304)적차이무통계학의의;자체골조기수보조환자여태망조전부환자상비,량방안술후정체감염솔차이무통계학의의(x2=0.007,P=0.931),단량방안적근기감염솔(x2=3.860,P=0.049)급원기감염솔(x2=3.962,P=0.047)적차이유통계학의의.결론 공제자체골조방안수보시간창위재거골판술후1～3개월내,림상효과교태망수보적방안호,우기재강저술후원기감염방면유명현우세.
Objective To investigate the differences of clinical efficacy and its reason of cranioplasty using frozen autologous bone and three-dimensional CT titanium mesh repair schemes.Methods A multicenter controlled study was performed in 216 patients who underwent cranioplasty using frozen autologous bone after decompressive craniectomy because of craniocerebral injury from January 2008 to December 2010,and 139 patients were treated with three-dimensional titanium mesh at the same period.The differences of intraoperative blood loss,duration of surgery,and related complications after procedure,as well as the differences between the short-(within a month after surgery) and long-term (1 month to 3 years after surgery) infections after procedure at different time windows of the two schemes were compared.Results There were significantly differences in intraoperative mean blood loss (t =10.205,P =0.000),mean operation time (t =13.957,P =0.000),uncomfortable at the operated area after procedure (x2 =7.565,P =0.006),fear of hot and cold (x2 =167.389,P =0.000),and fear of vibration (x2 =146.654,P =0.000) between the two repair schemes.There were no significantly differences in secondary epilepsy (P =0.563) and depressed deformation at the surgery area (P =0.304) between the two repair schemes.There was no significantly differences in the overall infection rate of the two schemes after procedure between the patients of the early autogenous bone repair group and those of the titanium mesh group (x2 =0.007,P =0.931),however,there was significantly difference in the recent infection rate (x2 =3.860,P =0.049) and long-term infection rate (x2 =3.962,P =0.047) between the two schemes.Conclusions The repair time window of the autologous bone group scheme was controlled within 1 to 3 months after craniectomy.The clinical effect was better than the titanium mesh repair scheme,in particular,it has obvious an advantage in reducing the long-term postoperative infection.
