【摘要】 目的探讨外伤性脑积水(PTH)合并颅骨缺损的手术治疗策略。方法回顾性分析36例PTH合并颅骨缺损病人的临床资料。其中同期实施脑室-腹腔分流术(V-P分流术)和颅骨修补术(同期手术组)11例,分期行V-P分流术和颅骨修补术(分期手术组)25例。通过比较两组病人手术前后GCS评分、临床症状改善及术后并发症等指标,评估两种治疗策略的效果。结果同期手术组术后GCS评分提高7例(64%),分期手术组术后GCS评分提高18例(72%)。两组在手术前后GCS评分、临床症状改善方面差异均无统计学意义(P>0.05)。同期手术组出现术后发热7例(63.6%),分期手术组4例(16.0%);分期手术组术后发热的发生率明显低于同期手术组(P<0.05)。结论 PTH合并颅骨缺损者优先考虑分期手术,且不同损伤类型的病人应采用不同的手术策略。更多还原

【Abstract】 Objective To explore the surgical strategy for patients with posttraumatic hydrocephalus(PTH) and cranial defect.Methods Clinical data of 36 patients with PTH and cranial defect was analyzed retrospectively.The concurrent ventriculo-peritoneal(V-P) shunt and cranioplasty were performed in 11 patients(concurrent operation group),and staging V-P shunt and cranioplasty(staging operation group) in 25.The efficacies of both surgical strategies were evaluated by GCS scores,improvement of clinical symptoms and postoperative complications.Results The postoperative GCS scores increased in 7 cases(64%) in concurrent operation group and 18(72%) in staging operation group.There was no statistical significance in differences of GCS scores and the improvement of clinical symptom before and after operations in both groups(P>0.05).Postoperative fever occurred in 7 cases(63.6%) in concurrent operation group and 4(16.0%) in staging operation group.The ratio of fever in staging operation group was obviously lower than in concurrent operation group(P<0.05).Conclusions Staging operation is the first choice for patients with PTH and cranial defect,and a patient with different type of trauma should receive different surgical strategy.更多还原