去骨瓣减压术后环锯综合征和反常性脑疝特征及诊治研究进展  

Advances in diagnosis and treatment of syndrome of trephined and paradoxical herniation after decompressive craniectomy

作　　者：范国锋 秦虎[1] 王增亮[1] 高勇 汪永新[1] Fan Guofengl;Qin Hu;Wang Zengliang;Gao Yong;Wang Yongxin(Department of Neurosurgery,First Affiliated Hospital of Xinjuuig Medical University, Urumchi 830011 , China)

机构地区：[1]新疆医科大学第一附属医院神经外科,乌鲁木齐830011

出　　处：《中华创伤杂志》2019年第5期430-434,共5页Chinese Journal of Trauma

基　　金：新疆维吾尔自治区卫生计生委青年人才专项基金(wjwy201818).

摘　　要：去骨瓣减压术降低创伤性脑损伤病死率的疗效已得到肯定,但同时伴随许多严重并发症.环锯综合征(ST)和反常性脑疝(PH)就是其中比较少见的并发症.ST的最主要表现是患者在去骨瓣减压术后数周至数月,因为皮瓣的下陷产生了一系列神经功能减退现象,这些神经功能障碍与后续的颅骨缺损修补有很大的关联.PH是在ST的基础上出现的进行性意识下降,颅骨缺损侧瞳孔出现变化,缺损骨窗部位触摸压力低,CT提示明显的中线移位和脑干受压等.ST和PH在病理生理学上有共同诱因,包括脑脊液动力、大气压力、脑血流量及脑内物质代谢等.ST及PH的诊断目前仍未达成共识,治疗上应尽早行颅骨修补.笔者对去骨瓣减压术后出现ST和PH的临床表现、病理生理学变化、诊断与治疗等方面进行综述,为临床医师进一步认识ST和PH提供参考。The efficacy of decompressive craniectomy (DC) in reducing traumatic brain injury mortality has been affirmed,but there are also many serious complications.Syndrome of the trephined (ST) and paradoxical herniation (PH) are rare complications.ST is characterized by a series of neurological deterioration due to skin flaps subsidence from weeks to months after DC.These neurological impairments are closely related to the subsequent repair of skull defects.PH shows progressive decrease in consciousness on the basis of ST,changes in pupils on the side of skull defects,low touch pressure at the defect window,and obvious midline shift and brain stem compression on CT.ST and PH have common inducements in pathophysiology,including cerebrospinal fluid dynamics,atmospheric pressure,cerebral blood flow and brain material metabolism.There is no consensus on the diagnosis of ST and PH,and early cranioplasty is suggested in terms of treatment.This article reviews the clinical manifestations,pathophysiological changes,diagnosis and treatment of ST and PH after DC operation,so as to provide references for clinicians to further understand ST and PH.

关 键 词：脑疝 减压颅骨切除术 环锯综合征 

分 类 号：R651.1[医药卫生—外科学]