改良颞肌分离方法颞肌间入路置入修补材料在颅骨修补术中的临床效果观察  

Clinical efficacy observation on a modified temporal muscle-splitting intermuscular approach for implanting repair materials in cranioplasty

作　　者：董策 刘卓群 默峰 潘宝根[1] 王琮 DONG Ce;LIU Zhuoqun;MO Feng;PAN Baogen;WANG Cong(Department of the Third Department of Neurosurgery,Hebei Provincial General Hospital,Shijiazhuang 050000,China)

机构地区：[1]河北省人民医院神经外三科,石家庄050000

出　　处：《浙江医学》2025年第6期651-654,658,共5页Zhejiang Medical Journal

摘　　要：目的观察改良颞肌分离方法颞肌间入路置入修补材料在颅骨修补术中的临床效果。方法回顾性选取2018年1月至2022年8月河北省人民医院神经外科收治的行颅骨修补术的颅骨缺损患者150例。其中78例患者术中采用改良颞肌分离方法颞肌间入路置入修补材料(观察组),72例患者术中采用常规颞肌分离方法颞肌下入路置入修补材料(对照组)。观察并比较两组患者术后3个月内癫痫发生情况、术前术后大脑血流灌注情况、术后并发症发生情况,分析患者术后癫痫发生的影响因素。结果观察组患者癫痫发生率低于对照组(2.6%比6.9%,P<0.05)。术后两组患者颅骨缺损区域脑血流量、大脑中动脉流速均大于术前(均P<0.05),且观察组均大于对照组(均P<0.05);术后修补材料下积血、积液及切口愈合不良发生率比较差异均无统计学意义(均P>0.05)。多因素分析显示,颅骨缺损面积、修补时间、颞肌分离方法均是患者术后癫痫发生的独立影响因素(均P<0.05),缺损面积≤85cm^(2)、去骨瓣减压术术后修补时间<3个月、改良颞肌分离方法均可降低癫痫发生风险。结论改良颞肌分离方法颞肌间入路置入修补材料用于颅骨修补术安全有效,可显著改善修补区域脑血流量,降低颅骨修补术后癫痫的发生风险。Objective To evaluate the clinical efficacy of a modified temporal muscle-splitting intermuscular approach for implanting repair materials in cranioplasty.Methods A retrospective analysis was conducted on 150 patients with skull defects who underwent cranioplasty at the Department of Neurosurgery,Hebei Provincial General Hospital,between January 2018 and August 2022.Among them,78 patients in the observation group received the modified temporal musclesplitting intermuscular approach for repair material implantation,while 72 patients in the control group underwent the conventional temporal muscle-splitting submuscular approach.Postoperative epilepsy incidence within 3 months,cerebral blood flow perfusion before and after operation,and postoperative complications,were compared between the two groups.Factors influencing postoperative epilepsy were analyzed.Results The observation group exhibited a significantly lower incidence of epilepsy than the control group(2.6%vs.6.9%,P<0.05).After operation,both groups showed increased cerebral blood flow in the skull defect area and middle cerebral artery velocity compared to preoperative values(P<0.05),with greater improvements observed in the observation group(P<0.05).No significant differences were found in postoperative subgraft hematoma,effusion,or poor wound healing between the two groups(P>0.05).Multivariate analysis identified skull defect area,repair timing,and temporal muscle-splitting method as independent risk factors for postoperative epilepsy(P<0.05).Specifically,defect area≤85 cm^(2),cranioplasty performed<3 months after decompressive craniectomy,and the modified temporal muscle approach significantly reduced epilepsy risk.Conclusion The modified temporal muscle-splitting intermuscular approach for cranioplasty is safe and effective,which improves regional cerebral perfusion,and reduces postoperative epilepsy risk.

关 键 词：改良颞肌保护 颞肌半分离 颅骨修补 脑血流量 癫痫 

分 类 号：R65[医药卫生—外科学]