郝旭东　张世渊

[摘要] 目的 评价早期应用颅骨修补术联合脑室腹腔分流术治疗脑外伤的临床效果及预后。方法 随机选取2013年3月—2015年3月在该院接受治疗的80例脑外伤患者进行研究，利用随机双盲法将其划分入对照组与实验组，各40例，所有患者均于受伤早期接受开颅血肿清除术与去骨瓣减压术治疗，术后3个月对照组行脑室腹腔分流术，再过3个月行颅骨修补术；实验组则在术后3个月时接受颅骨修补术联合脑室腹腔分流术，观察比较两组患者GCS评分、NHISS评分、并发症情况。 结果 实验组患者GCS评分优良率优于对照组（P<0.05）；与对照组相比，实验组NHISS评分下降明显（P<0.05）；实验组患者的术后并发症较对照组更低（P<0.05）。结论 对脑外伤患者早期施以颅骨修补术联合脑室腹腔分流术，患者预后与生存质量均得到改善，且并发症少，总体疗效良好。

[关键词] 脑外伤；颅骨修补术；脑室腹腔分流术；神经外科

[中图分类号] R651.11 [文献标识码] A [文章编号] 1674-0742（2015）12（a）-0009-03

[Abstract] Objective To evaluate the clinical effect and prognosis of cranioplasty combined with ventriculoperitoneal shunt in treatment of patients with brain trauma in early stage. Methods 80 cases with brain trauma treated in our hospital from March 2013 to March 2015 were selected and randomly divided into control group and experimental group with 40 cases in each. All the patients with brain trauma in early stage received craniotomy hematoma removal and decompressive craniectomy treatment， the control group were given ventriculoperitoneal shunt in three months after operation and cranioplasty in six months after operation， the experimental group were given cranioplasty combined with ventriculoperitoneal shunt in three months after operation. GCS score， NHISS score and complications of the two groups were observed and compared. Results The excellent and good rate of GCS score in the experimental group was better than that in the control group （P<0.05）. Compared with that in the control group， the NHISS score in the experimental group was obviously decreased （P<0.05）. The incidence of postoperative complications in the experimental group was lower than that in the control group（P<0.05）. Conclusion Cranioplasty combined with ventriculoperitoneal shunt in treatment of patients with brain trauma in early stage can improve the prognosis and quality of life of patients， and there are few complications and good global curative effect.

[Key words] Brain trauma； Cranioplasty； Ventriculoperitoneal shunt； Neurosurgery

颅脑外伤是神经外科常见的损伤类型，指的是头部在直接或间接暴力作用下引发的颅骨、脑膜、脑组织等的损伤，通常发生于交通事故与建筑工地等事故中[1]。随着近年来交通与建筑业的蓬勃发展，意外所致颅脑损伤发生率亦明显增加，因其伤及中枢神经系统，致残率与死亡率均高于其他部位损伤[2]。此类患者的传统治疗方式是先行脑室腹腔分流术，以达到使膨出脑组织回纳，降低颅内压的效果，脑室腹腔分流术后3～6个月再择期进行颅骨修补术，这样通常会导致患者错过最佳的康复阶段，而且增加了手术与麻醉风险[3]。现随机选取2013年3月—2015年3月在该院接受治疗的80例颅脑外伤患者为调查对象，评析早期应用颅骨修补术联合脑室腹腔分流术治疗的临床效果，及其对并发症与预后的影响，以期为日后临床工作提供参考依据，具体报告如下。……