去骨瓣减压术中人工硬脑膜松弛缝合的临床研究  

Clinical study on dural relaxing suture operation with artifical duramater in patients with removing bone valve decompressing

作　　者：袁鹏[1] 方波[1] 邹胜伟[1] 许毅[1] 

机构地区：[1]重庆市急救医疗中心神经外科,400014

出　　处：《重庆医学》2008年第11期1197-1199,共3页Chongqing medicine

摘　　要：目的通过在去骨瓣减压手术中比较应用新型生物人工硬膜松弛缝合与常规硬膜敞开减压的预后,探讨人工硬膜松弛缝合在神经外科去骨瓣减压术中的应用价值。方法将2005年5月至2007年5月因重型颅脑损伤行去骨瓣减压术的126例患者分为两组,其中分组条件即在去骨瓣减压中采用常规硬膜敞开式方法和人工硬膜松弛缝合方法,对其资料进行回顾性分析研究。结果两组术后CT表现及颅内压监测,均能达到减压目的,其颅内压变化两组之间差异无统计学意义。其中,常规硬膜敞开组62例,发生并发症46例。Ⅱ期颅骨修补过程中见硬膜外组织粘连程度重,分离创面出血多,分离后易发生纤维破损,甚至脑组织受损。人工硬膜修补组64例,发生并发症9例。Ⅱ期颅骨修补过程中见修补材料表面可见毛细血管,周边缝合的硬膜已完全愈合,粘连程度轻,分离创面出血少,分离纤维膜完整,脑组织无损伤。两组经统计学处理,差异有统计学意义(P<0.05)。结论人工硬膜松弛缝合在去骨瓣减压术中能够充分发挥有效的减压作用,基本保持原有解剖层次,显著降低去骨瓣减压术后的并发症发生率,值得临床推广。Objective Comparing the prognosis between dural relaxing suture with new biological artificial duramater and open wide dural operation in the patients with removing bone valve decompressing, to discuss the important singnicicance of dural relaxing suture operation with artifical duramater in neurosurgical removing bone valve decompressing. Methods From July 2004 to May 2007,126 cases of servere head-injury performed removing bone valve decompressing and secondary-stage plastic operation of defect of skull,were divided into two groups. Group one：open wide dural operation,and group two：dural relaxing suture with new biological artificial daramater. The data of two groups were analysed retrospectively. Results According to the results of CT scanning and ICP monitoring after operation,the surgical decompressing of two groups were clinical effective. ICP value in two groups had no statistical difference. Complications occurred in 46 cases performed open wide dural operation. On secondary-stage plastics of skull,extradural structure was confused. Tight tissue adhesion and much hemorrhage were observed in operation. Regeneration tissue even brain would be disrupted. Meanwhile complications happened in 9 patients performed plastic operation with artificial duramater. A large number of capillary vessel regenerated on artificial duramater which healed up completely. Distinct tissue structure and loose adhesion was displayed. Less hemorrhage occurred. Fibrous memberane was separated easily and brain tissue protected conveniently. Conclution Dural relaxing suture with artificial duramater on the patients performed removing bone valve decompression is effective. Original anatomic structure rehabilitates. Complications after removing bone valve decompression decrease significantly. This method might be apllied clinically.

关 键 词：去骨瓣减压术 人工硬脑膜 松弛缝合 

分 类 号：R651.15[医药卫生—外科学]