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目的探讨治疗重型颅脑创伤去骨瓣减压术后合并创伤后脑积水(PTH)患者的不同手术方案。方法回顾性分析89例重型颅脑创伤患者行开颅去骨瓣减压后合并创伤后脑积水的临床资料。以手术方式不同分为:早期组即早期行脑室-腹腔分流术(VPS)+颅骨修补术17例;延期组即延期行脑室-腹腔分流术(VPS)+颅骨修补术22例;先行VPS再行颅骨修补术组31例(先VPS组),先行颅骨修补术再行VPS组19例(后VPS组)。结果早期组、延期组、先VPS组和后VPS组治疗有效率分别为88.2%、86.4%、90.3%、89.5%,四组之间差异无统计学意义(P>0.05);且各组并发症中分流堵管率并无差异(P>0.05);早期组头皮感染发生率明显高于先行VPS组(17.6%VS6.5%),先VPS组及后行VPS组术后硬膜下积液或血肿发生率(分别为3.2%和5.2%)均明显低于早期组及晚期组(分别为11.76%和9.09;P<0.05)。结论针对重型颅脑创伤去骨瓣减压术后引起的创伤后脑积水患者,早期、晚期及先VPS组、后VPS组治疗方案选择无差异,手术方案的选择益于以患者病情而行。
Objective To investigate the different surgical treatment of patients with traumatic hydrocephalus (PTH) after decompressive craniectomy with craniocerebral trauma. Methods The clinical data of 89 patients with severe craniocerebral trauma who underwent traumatic decompressive craniectomy combined with traumatic hydrocephalus were retrospectively analyzed. According to the different surgical methods, 17 cases were treated with VPS + skull repair in the early group, 22 cases were delayed by VPS + skull repair in the deferred group, Thirty-one patients (group VPS) underwent skull repair and operated on cranial repair 19 patients (group VPS) after VPS. Results The effective rates of early treatment group, postponement group, pre-VPS group and post-VPS group were 88.2%, 86.4%, 90.3% and 89.5% respectively. There was no significant difference between the four groups (P> 0.05) (P> 0.05). The incidence of early scalp infection was significantly higher than that of the pre-VPS group (17.6% vs 6.5%). The rate of post-operative subdural product The rates of fluid or hematoma (3.2% and 5.2%, respectively) were significantly lower in the early and late groups (11.76% and 9.09, respectively; P <0.05). Conclusions There is no difference in treatment options between early Vet group, pre-VPS group and post-VPS group for patients with post-traumatic hydrocephalus caused by decompressive craniocerebral trauma and craniocerebral trauma. The choice of surgical procedure is beneficial to the patient’s condition.