CAJ | 학술논문

目的探讨颅骨缺损患者行数字化塑型钛网颅骨修补术前后的颅内压(ICP)、脑血流动力学及神经功能的变化,以及颅骨修补时机的选择. 方法回顾性分析什邡市人民医院神经外科自2009年6月至2014年5月收治的69例颅骨缺损患者在施行数字化塑型钛网颅骨修补术前后的ICP、脑血流速度变化以及颅骨缺损综合征症状、认知功能的改善情况,其中术前病理状态下ICP＜80 mmH2O 53例,≥80 mmH2O 16例;颅骨缺损至修补间隔时间为3-6月11例,6～9月25例,9～12月24例,＞12月9例. 结果颅骨修补术后患者ICP均在正常范围,较术前差异有统计学意义(P＜0.05);术后2周的颅内动脉平均血流速度均较术前明显改善,差异均有统计学意义(P＜0.05).69例患者均手术顺利,术后恢复良好.14例术前感觉、运动障碍者术后均有不同程度改善;4例癫痫发作者中3例未再发作,l例癫痫发作次数减少;2例言语障碍均有好转.术后54例颅骨缺损综合征均消失.69例患者术后3月GOS评分[(3.56±0.35)分]、FIM评分[(93.78±6.51)分]均较术前[(2.48±0.67)分、(77.91±10.32)分]明显提高,差异均有统计学意义(P＜0.05).早期(3～6月、6～9月、9～12月)行颅骨修补患者中,术后GOS评分、FIM评分较术前提升较高,差异均有统计学意义(P＜0.05).结论数字化塑型钛网颅骨修补可稳定颅骨缺损患者的ICP,改善脑病理性血流动力学状态,改善认知功能障碍,促进神经功能恢复,其中早期进行颅骨修补预后更好.
목적 탐토로골결손환자행수자화소형태망로골수보술전후적로내압(ICP)、뇌혈류동역학급신경공능적변화,이급로골수보시궤적선택. 방법 회고성분석십방시인민의원신경외과자2009년6월지2014년5월수치적69례로골결손환자재시행수자화소형태망로골수보술전후적ICP、뇌혈류속도변화이급로골결손종합정증상、인지공능적개선정황,기중술전병리상태하ICP＜80 mmH2O 53례,≥80 mmH2O 16례;로골결손지수보간격시간위3-6월11례,6～9월25례,9～12월24례,＞12월9례. 결과 로골수보술후환자ICP균재정상범위,교술전차이유통계학의의(P＜0.05);술후2주적로내동맥평균혈류속도균교술전명현개선,차이균유통계학의의(P＜0.05).69례환자균수술순리,술후회복량호.14례술전감각、운동장애자술후균유불동정도개선;4례전간발작자중3례미재발작,l례전간발작차수감소;2례언어장애균유호전.술후54례로골결손종합정균소실.69례환자술후3월GOS평분[(3.56±0.35)분]、FIM평분[(93.78±6.51)분]균교술전[(2.48±0.67)분、(77.91±10.32)분]명현제고,차이균유통계학의의(P＜0.05).조기(3～6월、6～9월、9～12월)행로골수보환자중,술후GOS평분、FIM평분교술전제승교고,차이균유통계학의의(P＜0.05).결론 수자화소형태망로골수보가은정로골결손환자적ICP,개선뇌병이성혈류동역학상태,개선인지공능장애,촉진신경공능회복,기중조기진행로골수보예후경호.
Objective To investigate the appropriate time of the skull reconstruction of skull defect,and explore the changes of intracmnial pressure,cerebral hemodynamic parameters,clinical symptoms and signs before and after cranioplasty with digital shaping titanium mesh.Methods The clinical data included parameter variations of noninvasive intracranial pressure (ICP),cerebral blood flow velocity,and improvement of skull defect syndrome and cognitive function were retrospectivly analyzed in 69 patients with skull defect received cranioplasty with digital shaping titanium mesh in our hospital from June 2009 to May 2014.The preoperative ICP less than 80 mmH2O was recorded in 53 patients and that more than or equal to 80 mmH2O was recorded in 16 patients.The interval time from the skull defects to cranioplasty was as follows:11 patients were within 3-6 months,25 were in 6-9 months,24 were in 9-12 months,and 9 were more than one year.Results The ICP after cranioplasty was in the normal range,which was statistically different as compared with that before cranioplasty (P＜0.05).The mean blood flow velocity two weeks after cranioplasty was improved significantly as compared with that before cranioplasty (P＜0.05).All 69 patients were recovered well postoperatively;14 patients with preoperative sensory and movement disorders got improvement of different degrees after cranioplasty;in the four patients with epilepsy,three were seizure-free,and the left one had obviously reduced epileptic seizure;two patients with speech disorders got improvement postoperatively.Skull defect syndrome symptoms in the 54 patients were disappeared.Significant differences of Glasgow outcome scale (GOS) and function independent measurement (FIM) scores were noted between before cranioplasty and three months after cranioplasty (2.48±0.67 vs.3.56±0.35;77.91±10.32 vs.93.78±6.51;P＜0.05).The GOS and FIM scores in patients performed cranioplasty at early stage (interval time from the skull defects to cranioplasty within 12 months) were significantly improved as compared with those before cranioplasty (P＜0.05).Conclusion The digital shaping titanium mesh skull reconstruction of skull defect could stabilize the ICP,and improve the dynamic state of pathological cerebral blood flow and cognition impairment,and is conducive to the recovery of nervous function;and early cranioplasty can have a good prognosis.