颞肌下改良术式在标准外伤大骨瓣减压术后颅骨缺损修补中的应用效果(1)
[摘要]目的 评价颞肌下改良术式在标准外伤大骨瓣减压术后颅骨缺损修补中的应用效果。方法 选取2016年12月～2018年1月在我院接受标准外伤大骨瓣减压术的74例患者作为研究对象，根据随机双盲法分为对照组(37例)与观察组(37例)。对照组接受常规单独颞肌下修补术，观察组接受颞肌下改良术式颞肌解剖复位修补术，比较两组患者的颅骨修补情况，并比较两组患者的手术效果。结果 观察组并发症总发生率(13.51%)低于对照组(37.84%)，差异有统计学意义(P<0.05)；观察组术后主观舒适度不佳总发生率(8.11%)低于对照组(29.73%)，差异有统计学意义(P<0.05)。结论 在标准外伤大骨瓣减压术后采取颞肌下改良术式，能够提高患者的颅骨修补效果，促使患者术后较快恢复，安全性高，临床价值确切。
[关键词]标准外伤大骨瓣减压术；颅骨缺损修补；颞肌下改良术式
[中图分类号] R651.11 [文献标识码] A [文章编号] 1674-4721(2018)11(c)-0086-03
[Abstract] Objective To evaluate the application effect of improved temporomandibular operation in repairing skull defect after standard traumatic large bone flap decompression. Methods A total of 74 patients with standard traumatic large bone decompression treated in our hospital from December 2016 to January 2018 were selected as the subjects， and divided into the control group (37 cases) and the observation group (37 cases). The control group received conventional submucosal repair. The observation group received a modified subarachnoid surgery iliac anatomical reduction and repair， and the skull repair of the two groups was compared. The surgical outcomes of the two groups were compared. Results The total incidence of complications in the observation group was 13.51%， which was lower than that in the control group (37.84%)， and the difference was statistically significant (P<0.05). The total incidence of poor subjective comfort in the observation group was 8.11%， which was lower than that in the control group (29.73%)， and the difference was statistically significant (P<0.05). Conclusion Under the standard traumatic large bone flap decompression， the improvement of the diaphragm under the diaphragm can improve the repair effect of the patients′ skull， prompt the patient to recover quickly， with high safety and clinical value.
[Key words] Standard trauma large bone flap decompression； Skull defect repair； Improved temporomandibular operation
危急重癥颅脑疾病是临床常见危重疾病，随着大骨瓣开颅技术的应用，使危急重症颅脑疾病患者存活率及生活质量明显提高。标准外伤大骨瓣减压术是临床治疗颅脑疾病的主要方法，成为治疗额颞顶部重型颅脑损伤患者的标准术式[1]。在手术过程中，由于骨瓣去除范围大，额底、颞底的颅骨生理曲度变化明显，与眉弓、颧突、额窦、乳突气房等组织结构关系密切，明显增加了颅骨损伤修补难度。颅骨缺损修补是目前临床重点关注的问题，尤其是颅骨成形的重要性，修补材料及修补方法的选择受到临床广泛认可[2-3]。随着数字化塑形钛网技术的开展，术中无需塑形，塑性效果显著，术后并发症少，使颅骨缺损修补效果明显提高。本研究旨在探讨颞肌下改良术式在标准外伤大骨瓣减压术后颅骨缺损修补中的应用效果，现报道如下。
1资料与方法
1.1 一般资料
选取2016年12月～2018年1月在我院接受标准外伤大骨瓣减压术的74例患者作为研究对象，根据随机双盲法分为两组。观察组37例，其中男23例，女14例；年龄20～68岁，平均(41.25±8.52)岁；颅骨缺损范围：7.81 cm×10.40 cm～12.54 cm×15.11 cm，平均(148.74±21.52)cm2。对照组37例，其中男24例，女13例；年龄20～68岁，平均(41.30±8.51)岁；颅骨缺损范围：7.74 cm×10.38 cm～12.58 cm×15.20 cm，平均(149.02±21.48)cm2。两组患者的一般资料比较，差异无统计学意义(P>0.05)，具有可比性。患者骨窗压力不高，均有不同程度的塌陷；患者术后恢复效果良好，能满足手术沟通交流；无手术禁忌证；患者术后遗留不同程度的额颞顶部颅骨缺损；患者对研究知情并签署了研究同意书。本研究经医院医学伦理委员会审核批准。, 百拇医药(杨杰 杨俊博)
[关键词]标准外伤大骨瓣减压术；颅骨缺损修补；颞肌下改良术式
[中图分类号] R651.11 [文献标识码] A [文章编号] 1674-4721(2018)11(c)-0086-03
[Abstract] Objective To evaluate the application effect of improved temporomandibular operation in repairing skull defect after standard traumatic large bone flap decompression. Methods A total of 74 patients with standard traumatic large bone decompression treated in our hospital from December 2016 to January 2018 were selected as the subjects， and divided into the control group (37 cases) and the observation group (37 cases). The control group received conventional submucosal repair. The observation group received a modified subarachnoid surgery iliac anatomical reduction and repair， and the skull repair of the two groups was compared. The surgical outcomes of the two groups were compared. Results The total incidence of complications in the observation group was 13.51%， which was lower than that in the control group (37.84%)， and the difference was statistically significant (P<0.05). The total incidence of poor subjective comfort in the observation group was 8.11%， which was lower than that in the control group (29.73%)， and the difference was statistically significant (P<0.05). Conclusion Under the standard traumatic large bone flap decompression， the improvement of the diaphragm under the diaphragm can improve the repair effect of the patients′ skull， prompt the patient to recover quickly， with high safety and clinical value.
[Key words] Standard trauma large bone flap decompression； Skull defect repair； Improved temporomandibular operation
危急重癥颅脑疾病是临床常见危重疾病，随着大骨瓣开颅技术的应用，使危急重症颅脑疾病患者存活率及生活质量明显提高。标准外伤大骨瓣减压术是临床治疗颅脑疾病的主要方法，成为治疗额颞顶部重型颅脑损伤患者的标准术式[1]。在手术过程中，由于骨瓣去除范围大，额底、颞底的颅骨生理曲度变化明显，与眉弓、颧突、额窦、乳突气房等组织结构关系密切，明显增加了颅骨损伤修补难度。颅骨缺损修补是目前临床重点关注的问题，尤其是颅骨成形的重要性，修补材料及修补方法的选择受到临床广泛认可[2-3]。随着数字化塑形钛网技术的开展，术中无需塑形，塑性效果显著，术后并发症少，使颅骨缺损修补效果明显提高。本研究旨在探讨颞肌下改良术式在标准外伤大骨瓣减压术后颅骨缺损修补中的应用效果，现报道如下。
1资料与方法
1.1 一般资料
选取2016年12月～2018年1月在我院接受标准外伤大骨瓣减压术的74例患者作为研究对象，根据随机双盲法分为两组。观察组37例，其中男23例，女14例；年龄20～68岁，平均(41.25±8.52)岁；颅骨缺损范围：7.81 cm×10.40 cm～12.54 cm×15.11 cm，平均(148.74±21.52)cm2。对照组37例，其中男24例，女13例；年龄20～68岁，平均(41.30±8.51)岁；颅骨缺损范围：7.74 cm×10.38 cm～12.58 cm×15.20 cm，平均(149.02±21.48)cm2。两组患者的一般资料比较，差异无统计学意义(P>0.05)，具有可比性。患者骨窗压力不高，均有不同程度的塌陷；患者术后恢复效果良好，能满足手术沟通交流；无手术禁忌证；患者术后遗留不同程度的额颞顶部颅骨缺损；患者对研究知情并签署了研究同意书。本研究经医院医学伦理委员会审核批准。, 百拇医药(杨杰 杨俊博)