中华神经创伤外科电子杂志2019，Vol.5Issue(1)：15-19,5.DOI:10.3877/cma.j.issn.2095-9141.2019.01.004
优先颅骨修补后行脑积水分流术治疗创伤性脑积水合并颅骨缺损的疗效分析
Rapeutic effect of hydrocephalus shunting after preferred cranioplasty for traumatic hydrocephalus with skull defect
摘要
Abstract
Objective To explore the post-traumatic hydrocephalus (PTH) combined with skull defect patients undergoing cranioplasty and hydrocephalus shunting, and its clinical significance in reducing postoperative complications and improving prognosis. Methods Thirty-two patients with PTH and skull defect treated in Zoucheng Hospital, Affiliated Hospital of Jining Medical College from January2012 to October 2017 were selected as the study subjects, and all patients underwent cranioplasty with three-dimensional plastic titanium mesh. There were patients with obvious encephalocele in the bone window area. During cranioplasty, direct ventricular puncture was used to release cerebrospinal fluid to promote the reduction of the encephalocele tissue in order to facilitate the coverage and fixation of titanium mesh. According to the changes of clinical symptoms of hydrocephalus, patients who meet the shunt indications will be selected for CSF shunt 1-3 weeks after cranioplasty. Observe the overall complications and good prognosis of GOS 6 months after operation. Results All 32 patients were treated with cranioplasty successfully without obvious complications. Twenty-eight cases were treated with hydrocephalus shunt operation. The symptoms of hydrocephalus in 4 cases reduced gradually after cranioplasty, and these patients received no shunt operation. The improvement rate of hydrocephalus symptoms was 94％ compared with preoperative, and the total complication rate was 6.25％. After 6months follow-up, the good prognosis was achieved in 24 cases, moderate disability in 4 cases, severe disability in 3 cases, and death in 1 case. Conclusion For all patients with PTH complicated with skull defect, it is a feasible operative method to repair the skull first and then reperform hydrocephalus shunt according to the patient's condition. The overall complication rate of operation is lower than that of the patients with PTH. It is of great clinical significance to improve the prognosis of the patients.关键词
创伤性脑积水/颅骨缺损/颅骨修补术/分流术Key words
Post-traumatic hydrocephalus/Skull defect/Cranioplasty/Shunt引用本文复制引用
王子敬,张洪钿,李晓光,于怀松,刘佰运..优先颅骨修补后行脑积水分流术治疗创伤性脑积水合并颅骨缺损的疗效分析[J].中华神经创伤外科电子杂志,2019,5(1):15-19,5.基金项目
国家自然科学基金 (81371345) （81371345）
