基于改良颞肌外术式钛网修补颅骨缺损的临床应用体会  

Experience of clinical application in repair of skull defect with titanium mesh based on modified external temporal muscle operation

作　　者：陈云祥 何国栋 范越君[1] CHEN Yunxiang;HE Guodong;FAN Yuejun(Affiliated Jinhua Hospital,Zhejiang University School of Medicine.Zhejiang,321000,China)

机构地区：[1]浙江大学附属金华医院,金华321000

出　　处：《浙江创伤外科》2021年第2期202-204,共3页Zhejiang Journal of Traumatic Surgery

摘　　要：目的探讨改良颞肌外术式进行颅骨缺损钛网修补的临床疗效。方法回顾性分析2014年1月至2019年12月本院颅骨缺损修补病例217例,其中改良颞肌外术式修补77例,颞肌外术式修补71例,颞肌下术式修补69例,在手术时间、硬膜破损率、术后并发症(脑挫伤、癫痫、钛网外露等);术后对钛网松动、主观不适感觉(异物感、颞肌疼痛、咀嚼无力)进行比较。结果手术时间方面:颞肌外术式最短(95.7±15.3)分钟、改良颞肌外术式次之(100.1±16.2)分钟、颞肌下术式最长(151.8±20.6)分钟,P<0.05;硬膜破损率颞肌下术式最高为9/69,颞肌外1/71、改良颞肌外术式2/77,P<0.05;术后新发癫痫率颞肌下术式7/69,颞肌外1/71、改良颞肌外术式1/77,P<0.05;三种术式均无钛网外露及钛网松动情况;主观感觉方面颞肌外术式最差,主要表现为颞肌疼痛,近颞底钛网异物感明显,P<0.05;咀嚼无力方面三者无明显统计学意义。结论改良颞肌外术式进行颅骨缺损钛网修补安全可行,兼顾了传统颞肌外修补术式的高效及颞肌下修补术式的外观及主观感受,实用性强,值得推广。Objective To investigate the clinical effect of titanium mesh repair of skull defect with modified temporal muscle surgery.Methods 217 cases of skull defect repair in our hospital from 2014 to 2019 were analyzed retrospectively, including modified external temporal muscle repair(n=77), external temporal muscle repair(n=71) and subtemporal muscle repair(n=69). In terms of operation time, dural rupture rate,postoperative complications(brain contusion, epilepsy, titanium mesh exposure, etc.), postoperative titanium mesh loosening, subjective discomfort(foreign body sensation, temporal muscle pain, masticatory weakness) were compared. Results In terms of operation time, temporal muscle surgery was the shortest(95.7 ±15.3)min, modified temporal muscle surgery was the second(100.1 ±16.2) min, subtemporal muscle surgery was the longest(151.8 ±20.6)min, P <0.05, the highest rate of dural rupture was 9/69, external temporal muscle surgery was 1/71, and modified temporal muscle surgery was 2/77(P<0.05). The new incidence of epilepsy after operation was 7/69 in under temporal muscle, 1/71 in outside temporal muscle and 1/77 in modified external temporal muscle(P <0.05). There was no titanium mesh exposure and loosening in all three operations. The subjective sensation of temporal muscle operation was the worst, mainly manifested as temporal muscle pain and obvious sensation of titanium mesh foreign body near temporal floor(P<0.05). There was no significant statistical significance in masticatory weakness. Conclusion The modified external temporal muscle repair of skull defect with titanium mesh is safe and feasible, taking into account the high efficiency of the traditional external temporal muscle repair and the appearance and subjective feeling of the subtemporal muscle repair. It is practical and worth popularizing.

关 键 词：颅骨缺损 手术 颞肌下颞肌外 改良颞肌外 

分 类 号：R651.1[医药卫生—外科学]