李汉城 杨克 吴植念 谢乐辉

【摘要】 目的 探讨标准大骨瓣减压术后应用数字成型三维钛网进行颞肌下与颞肌外颅骨修补术的临床治疗效果。方法 62例标准大骨瓣减压术后额颞顶区颅骨缺损患者作为研究对象， 根据不同手术方式分为颞肌外组与颞肌下组， 每组31例。颞肌下组采取颞肌下颅骨修补术进行治疗， 颞肌外组采取颞肌外颅骨修补术进行治疗。比较两组的手术时间及术后并发症发生情况。结果 颞肌外组的手术时间为（2.67±0.59）h， 与颞肌下组的手术时间（2.89±0.47）h比较， 差异无统计学意义（P>0.05）。颞肌下组皮下积液、咀嚼受限发生率分别为6.45%、0， 均低于颞肌外组的25.81%、16.13%， 差异均具有统计学意义（P<0.05）。两组切口感染、脑膜或脑损伤、脑内血肿、癫痫发生率比较， 差异均无统计学意义（P>0.05）。结论 标准大骨瓣减压术后应用颞肌下颅骨修补术的应用效果显著， 且该手术方法与生理解剖结构的复位较为接近， 并且手术后的并发症发生率较低， 临床手术治疗时间较短， 有助于神经功能的恢复与继发性损伤的减少， 值得临床进一步将其推广与应用。

【關键词】 颅骨缺损；标准大骨瓣减压术；颅骨修补术；颞肌下；颞肌外

DOI：10.14163/j.cnki.11-5547/r.2018.11.008

【Abstract】 Objective To discuss the clinical effect of cranioplasty under and outside musculi temporalis with digitally-formed three-dimensional titanium mesh after standard large trauma craniotomy. Methods A total of 62 skull defect in frontal dome area patients after standard large trauma craniotomy as study subjects were divided by different surgical methods into outside musculi temporalis group and under musculi temporalis group， with 31 cases in each group. Under musculi temporalis group was treated with cranioplasty under musculi temporalis， and outside musculi temporalis group was treated with cranioplasty outside musculi temporalis. Comparison were made on operation time and occurrence of postoperative complications between the two groups. Results Outside musculi temporalis group had operation time as （2.67±0.59） h， and it had no statistically significant difference comparing with （2.89±0.47） h in outside musculi temporalis group （P>0.05）. Under musculi temporalis group had lower incidence of subcutaneous effusion and chewing restriction respectivelya s 6.45% and 0 than 25.81% and 16.13% in outside temporalis group， and the difference was statistically significant （P<0.05）. Both groups had no statistically significant difference in incidence of incisional infection， meningeal or brain injury， intracerebral hematoma， and epilepsy （P>0.05）. Conclusion The application of cranioplasty under musculi temporalis after standard large trauma craniotomy shows remarkable effect and the surgical method is close to the reduction of the physiological anatomy， with low incidence of complications after surgery and shorter clinical surgical treatment time. It is helpful for the recovery of neurological function and the reduction of secondary injuries. It is worthy of further promotion and application in clinic.

【Key words】 Skull defect； Standard large trauma craniotomy； Cranioplasty； Under musculi temporalis； Outside musculi temporalis

标准大骨瓣减压术治疗脑颅外伤症状具有显著的促进作用， 能有效改善患者的昏迷状态、生理自理能力以及肢体运动能力， 因此医师常采取标准大骨瓣减压术为患者进行临床治疗[1]。但是， 在进行标准大骨瓣减压术后颅骨缺损不仅会严重影响患者的美观， 而且还会影响患者手术后的恢复， 引起术后并发症的发生。颅骨修补术有助于恢复患者的解剖结构， 起到美观与防止并发症发生的作用， 其颅骨修补术方法主要分为颞肌下与颞肌外两种颅骨修补术方法方法， 临床上对于这两种颅骨修补方法有不同的观点与看法[2]。本……