外伤性颅骨缺损修复前后灌注CT评价脑血流变化的研究  

Study on perfusion CT evaluation of cerebral blood flow changes before and after repairing of traumatic skull defects

作　　者：李鑫[1] 李晶[2] 李京生[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050 [2]首都医科大学附属北京天坛医院手术室

出　　处：《中华神经外科杂志》2015年第7期702-706,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨颅骨修复术对外伤性颅骨缺损患者脑血流动力学和神经症状的影响。方法对14例外伤性颅骨缺损患者颅骨修复前后行脑灌注CT检查，比较修补侧基底节层面与侧脑室体部层面的底节区和颞叶皮层区4组感兴趣区，自身对照比较其rCBF均值差别，分别比较术前与术后7d，术前与术后6个月均值，并且对其神经症状变化情况进行随访。结果（1）基底节层面底节区：术后7drCBF较术前有改善，P=0．044〈0．05；6个月随访rCBF较术前有改善，P=0．033〈0．05。（2）基底节层面颞叶皮层：术后7drCBF较术前有改善，P=0．001〈0．01；6个月随访rCBF较术前有改善，P=0．000〈0．01。（3）侧脑室体部层面底节区：术后7drCBF较术前无明显改善，P=0．275〉0．05；6个月随访rCBF较术前有明显改善，P=0．001〈0．05。（4）侧脑室体部层面颞叶皮层：术后7drCBF较术前无明显改善，P=0．064〉0．05；6个月随访rCBF较术前无明显改善，P=0．174〉0．05。其中发现靠近侧裂大血管处基底节水平层面脑组织血流因颅骨修复得以改善的程度更加明显。患者修复术后神经症状得到改善。结论本研究应用灌注CT数据说明脑血管分布越密集，脑血流量恢复越明显，进一步充实完善了颅骨修复后脑血管储备功能改善的理论假说。Objective To investigate the effect of cranioplasty on cerebral hemodynamics and neurological symptoms in patients with traumatic skull defect. Methods Before and after skull repair, 14 patients with traumatic skull defects underwent brain pcffusion CT examination. The basal ganglia level on the repair side and the basal ganglia region of the lateral ventricle body level and the temporal cortex region in 4 regions of interest were compared. Self-control comparison the mean value difference of rCBF, the mean values at 7 days before and after procedure and at 6-month before and after procedure were compared respectively, and the changes of their neurological symptoms were followed up. Results （ 1 ） The basal ganglia section of the basal ganglia level ： The rCBF was improved at 7 day after procedure compared with before procedure （ P = 0. 044, P 〈 0.05 ） ; the rCBF was improved for 6-month follow-up compared with before procedure （P = 0. 033, P 〈 0.05 ）. （ 2 ） The temporal cortex of the basal ganglia level ： The rCBF was improved at 7 day after procedure compared with before procedure （ P =0. 001, P 〈0.01 ） ; the rCBF was improved for 6-month follow-up compared with before procedure （ P = 0. 000, P 〈 0.01 ）. （3） The basal ganglia section of the lateral ventricle body level： The rCBF was not improved significantly at 7 day after procedure compared with before procedure （ P = 0. 275, P 〉 0. 05 ） ; the rCBF was improved significantly for 6-month follow-up compared with before procedure （ P = 0. 001, P 〈 0.05 ）. （ 4 ） The temporal cortex of the lateral ventricle body level： The rCBF was not improved significantly at 7 day after procedure compared with before procedure （P = 0. 064, P 〉 0.05 ） ; the rCBF was not improved for 6-month follow-up compared with before procedure （ P = 0. 174, P 〉 0. 05 ）. The degree of cerebral blood flow improvement was found more obviously near the large vessels at the lateral fissure on basal ganglia level because of sku

关 键 词：颅骨修复术 脑血流量 灌注CT 

分 类 号：R816.1[医药卫生—放射医学] R651.1[医药卫生—临床医学]