皮肌瓣一次性分离技术在额颞部颅骨修补术中的应用  

Application of one-time separation of musculocutaneous flap in frontotemporal cranioplasty

作　　者：王耿焕[1] 颜羽 沈和平[1] 褚正民[1] 沈建国[1] 朱坤灿[1] Wang Genghuan;Yan Yu;Shen Heping;Chu Zhengmin;Shen Jianguo;Zhu Kuncan(Department of Neurosurgery,the Second Affiliated Hospital of Jiaxing University,Jiaxing 314000,China;Zhejiang Chinese Medical University,Hangzhou 310053,China)

机构地区：[1]嘉兴学院附属第二医院神经外科,嘉兴314000 [2]浙江中医药大学,杭州310053

出　　处：《中华神经外科杂志》2023年第3期274-278,共5页Chinese Journal of Neurosurgery

基　　金：浙江省医药卫生科技计划(2022KY1257);嘉兴市科技计划(2018AD32004);浙江省医学会临床科研基金(2021ZYC-A150)。

摘　　要：目的对比分析皮肌瓣一次性分离技术在额颞部颅骨修补术中的应用优势。方法回顾性分析2015年1月至2020年12月于嘉兴学院附属第二医院神经外科行额颞部钛网颅骨修补术患者的临床资料,共242例。其中采用皮肌瓣一次性分离技术(试验组)75例(31.0%),常规手术方法(常规手术组)167例(69.0%)。比较两组患者的手术时长、术中硬脑膜悬吊和脑膜破损率、术后引流量,住院时长,以及眼部肿胀、皮下积液、面神经损伤、癫痫、切口感染、脑积水发生率的差异。结果与常规手术组比较,试验组术后的引流量[(184.1±45.1)ml对比(254.3±52.3)ml]少、眼部肿胀[9.3%(7/75)对比92.2%(154/167)]和皮下积液[20.0%(15/75)对比34.1%(57/167)]的发生率低,差异均有统计学意义(均P<0.05),试验组术后无一例患者发生面神经损伤,与常规手术组的5.4%(9/167)比较,差异有统计学意义(P<0.05)。而手术时长、术中脑膜破损和行硬脑膜悬吊的比率、术后住院时长和切口感染的发生率,两组比较差异均无统计学意义(均P>0.05)。术后随访3个月至2.5年,中位数为1.2年,癫痫、脑积水的发生率,两组比较差异均无统计学意义(均P>0.05)。结论在额颞部颅骨修补术中应用皮肌瓣一次性分离技术,能减少术后引流量,降低眼部肿胀、皮下积液及面神经损伤的风险。Objective To compare and analyze the application advantages of one-time separation of musculocutaneous flap in frontotemporal cranioplasty.Methods The clinical data of 242 patients who underwent frontotemporal cranioplasty at the Neurosurgery Department of the Second Affiliated Hospital of Jiaxing University from January 2015 to December 2020 were retrospectively analyzed.Among them,75 cases(31.0%)underwent one-time musculocutaneous flap separation(experimental group),and 167 cases(69.0%)were treated with conventional surgery(conventional group).The operation time,intraoperative dural suspension and meningeal damage rate,postoperative drainage volume,eyelid swelling,subcutaneous effusion,facial nerve injury,epileptic seizure,incision infection,incidence of hydrocephalus and postoperative hospital stay were compared between the two groups.Results Compared with conventional group,the experimental group had lower postoperative drainage volume(184.1±45.1 ml vs.254.3±52.3 ml),lower rates of eyelid swelling[9.3%(7/75)vs.92.2%(154/167)]and subcutaneous effusion[20.0%(15/75)vs.34.1%(57/167)](all P<0.05).There was no facial nerve injury in the experimental group after surgery,which was reported with the rate of 5.4%(9/167)in the conventional group,and the difference was significant(P<0.05).However,there was no significant difference between the two groups in the length of operation,the rate of meningeal damage or dural suspension during operation,postoperative hospital stay or the incidence of incision infection(all P>0.05).Postoperative follow-up lasted for 3 months to 2.5 years,with a median of 1.2 years.There was no significant difference in the incidence of epileptic seizure or hydrocephalus between the two groups(both P>0.05).Conclusion Application of the technique of one-time separation of musculocutaneous flap in frontotemporal cranioplasty can reduce postoperative drainage volume and the risks of eyelid swelling,subcutaneous effusion and facial nerve injury.

关 键 词：颅骨修补 皮肌瓣 手术后并发症 治疗结果 

分 类 号：R651.1[医药卫生—外科学]