标准大骨瓣减压术后两种颅骨修补方式的比较-第三军医大学学报.DOC

标准大骨瓣减压术后两种颅骨修补方式的比较 黄警锐 程凯敏 刘科 重庆市第四人民医院神经外科，400014 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行颞肌下或颞肌外颅骨修补的特点。方法 回顾分析我科107例行标准大骨瓣减压术后2~5个月应用数字成型三维钛网行颞肌下（55例）或颞肌外（52例）颅骨修补术后的临床资料，根据手术时间、出血量等手术情况，术后皮下积液、感染、术后出血、钛网松动等术后并发症，外观异常、疼痛、咀嚼受限等术后病人主观舒适度的情况进行多方面的比较。结果 两种修补方式在手术时间和出血量方面无明显差异；颞肌外组术后并发症明显多于颞肌下组；术后舒适度方面，颞肌下组优于颞肌外组。结论 应用数字成型三维钛网行颞肌下修补更接近生理结构，术后病人满意度高，功能恢复满意，较颞肌外组更符合临床要求。 关键词：颞肌下颅骨修补术；颞肌外颅骨修补术；术式比较 Contrast analysis of two skull osteoplastys after the standard large trauma craniotomy HUANG Jing-rui，CHENG Kai-min，Liu Ke (Department of neurosurgery，the People’s Hospital of Chongqing，400014，China) Abstract:Objective Investigate the skull osteoplasty characters of the under temporalis / outside temporalis employing digit forming triaxiality titanium net after the standard large trauma craniotomy. Methods Retrospective analysis 107 skull osteoplasty cases clinical data which under temporal muscle(55) / outside temporal muscle(52) employing digit forming triaxiality titanium net after 2~5 months postoperation, according to operation condition(time, hemorrhage volume); postoperative complications(postoperative subcutaneous hydrops, infection, postoperative hemorrhage, titanium net loosening), the postoperation subjective comfort level of the patient(shape abnormality, pain, chewing limitation ). Results The two operation methodes have no obvious difference in operation time/hemorrhage volume. The outside temporalis group have obvious difference in postoperative complications(p0.05). The under temporalis group are good at outside temporalis group in postoperation comfort level. Conclusion The under temporalis skull path methods employing digit forming triaxiality titanium net furthermore approach to physiology structure, high patient satisfaction, good function recovery; furthermore consistenting with the clinical demand. Key words ：the under temporalis skull osteoplasty；the outside temporalis skull osteoplasty； operation type comparison 在神经外科手术中,为了取得满意的外减压效果，手术医师往往选择行额颞顶标准大骨瓣减压（1）。而病