目的总结针对不同材料颅骨修补术患者的临床护理方法.方法回顾性分析32例施行颅骨缺损修补患者的临床疗效.探讨针对不同颅骨缺损修补术患者并发症的护理观察与分析.结果本组术后并发症发生率为18.75%,皮下积液是颅骨修补最常见的并发症,及时发现和采取有效护理措施是降低并发症的关键之一.结论手术效果与修补材料、操作技术相关,恰当的护理方法可以促进患者的顺利康复,减少并发症的发生.

Objective: To summarize the clinical nursing- care ways to the patient whose skull defect is repaired with different materials. Method: Based on the retrospective analysis to the clinical curative effect on the 32 cases, we can have an inquiry into the clinical nursing care observation and analysis which originate from the nursing care to the complications of the skull defect repair operation. Results: To discover timely and to undertake effective nursing care is the key to reduce the complications, whose rate is 18.75% , and among which subcutaneous effusion is the most. Conclusion: In spite of the materials and techniques, proper nursing care way can contribute to the recovery and the reduce of the complications.

目的对比采用普通二维钛网和电脑塑形三维钛网进行颅骨缺损修补的临床应用效果。方法24例颅骨缺损病人采用普通二维钛网进行颅骨修补,29例颅骨缺损病人采用电脑塑形三维钛网进行颅骨修补。结果三维组术后感染、术后翘边和术后皮下积液发生率低于二维组,但差异无统计学意义;三维组在手术平均用时、螺钉平均使用数量和塑形满意度方面明显优于二维组,差异有统计学意义;三维组住院平均费用明显高于二维组,差异有统计学意义。结论钛合金是修补缺损颅骨的理想替代材料。传统的二维钛网颅骨修补费用较低,但手术操作费时费力,术后并发症较多,塑形满意度低。电脑塑形三维钛网虽然费用较高,但其保留了二维钛网的优良特性,而且手术操作方便快捷,术后并发症少,塑形效果满意。

Objective To compare the traditional two-dimensional (2-D) titanium mesh and three-dimensional (3-D) computed shaping titanium mesh in cranioplasty .Methods 24 patients were treated using the ordinary 2-D titanium mesh and 29 were treated using 3-D computed shaping titanium mesh .Results The postoperative infections , the postoperative edge warping and the postoperative hydrops of 3-D group were lower than those in 2-D group.But there were no significant differences .3-D group has been shown to have several advantages over 2-D group in average operation time ,the average quantity of screws using and the satisfaction of shaping .And differences were significant . Average hospitalization costs of 3-D group was obviously higher than that of 2-D group,the difference was statistically significant .Conclusions Titanium alloy is the ideal replacing material in repairing skull defect .Although the traditional 2-D titanium mesh is economical ,there are more postoperative complications with more

目的 探讨聚维酮碘冷冻保存自体颅骨骨瓣回植修补颅骨缺损的远期疗效.方法 30例颅脑手术去骨瓣减压患者采取自愿形式,将术中取下的颅骨骨瓣用聚维酮碘冷冻保存,保存前用0.9％氯化钠注射液清洗骨瓣,然后行冲洗液细菌培养,待3～6个月后行颅骨缺损修补术;术后评估手术疗效.结果 30例中1例出现伤口感染,行修补骨瓣取出术;1例因术后脑积水再次行脑室腹腔分流术致颅内感染死亡;1例因术后5h复查CT发现硬膜外血肿,行硬膜外血肿清除术;1例出现少量头皮下积液,自行吸收;其余26例无感染、硬膜下或硬膜外血肿、皮瓣坏死等自体颅骨骨瓣回植修补颅骨缺损手术成功率为86.7％ (26/30).术后复查头颅CT对位良好,颅骨解剖复位.随访1个月～5年,均恢复良好,没有钛板等其他修补材料和其他自体颅骨保存回植法的并发症,复查CT示部分骨瓣与骨窗边缘骨性愈合.结论 聚维酮碘冷冻保存自体颅骨骨瓣回植修补颅骨缺损是一种可靠、安全、便捷的方法.

Objective To study about the long-term effect of povidone iodine cryopreservation technique in self-skull repairing operation.Methods Totally 30 patients taken craniocerebral surgical operation participated in this research voluntarily.The skull bone flap was removed during the neurosurgery and was cryopreserved with povidone iodine preservative liquid.Before preservation,the skull bone flap was cleaned with 0.9％ sodium chloride solution,and the liquid after washing was collected for microbiological analysis.The skull bone flap would be cryopreserved for 3 to 6 months and used for self-skull repairing operation.Results In total 30 cases,wound infection occured in 1 case and the repaired skull bone flap was removed later; 1 dead case had intracranial infection after the ventricle peritoneal drainage treating postoperative hydrocephalus; postoperative extradural hematoma was in 1 case via CT examination 5 hours after the original neurosurgery and the patient received the remov

背景：重型颅脑损伤开颅手术需要保持硬脑膜的完整性，人工硬脑膜是目前常见的硬脑膜修补材料，寻找理想的人工硬脑膜是神经外科探索的方向。 目的：探讨胶原海绵人工硬脑膜修补重型颅脑损伤的效果。 方法：回顾性分析96例重型颅脑损伤患者的临床资料，其中64例采用胶原海绵人工硬脑膜在不缝合情况下修补硬脑膜缺损，32例采用常规硬脑膜在严密缝合下修补硬脑膜缺损。观察两组开颅血肿清除手术时间、出血量及术后机械通气时间、ICU 监护时间、总的住院天数；开颅血肿清除到颅骨修补的时间间隔、颅骨修补手术时间及出血量、硬脑膜破损及修补后6个月格拉斯哥昏迷评分。 结果与结论：两组均能达到减压目的。两组之间开颅血肿清除手术出血量、术后机械通气时间、ICU 监护时间、总的住院天数、硬脑膜修补后6个月格拉斯哥昏迷评分比较差异无显著性意义(P >0.05)；胶原海绵人工硬脑膜组开颅血肿清除手术时间、颅骨修补硬脑膜破损、颅骨修补手术时间及出血量低于常规硬脑膜组(P <0.05)。表明胶原海绵人工硬脑膜在重型颅脑损伤中在充分发挥减压作用，维持脑功能，缩短手术时间的优势上，能达到和严密缝合硬脑膜同样的效果，为后期颅骨修补创造有利条件。

BACKGROUND:Craniotomy for severe traumatic brain injury is required to maintain the integrity of the dura mater. The artificial dura mater is now a common dural repair material, and looking for the ideal artificial dura mater is the exploring direction of neurosurgery. OBJECTIVE:To explore the application of colagen sponge artificial dura in severe traumatic brain injury METHODS:A retrospective analysis of 96 patients with severe head injury was performed, including 32 cases of the artificial dura with tightly suturing as the control group, and 64 cases of the artificial dura of colagen sponge without suturing as the experimental group. Operating time for hematoma clearance, blood loss, postoperative mechanical ventilation time, ICU monitoring time, the total number of hospitalized days as wel as time interval from hematoma clearance to cranioplasty, operative time for cranioplasty, blood loss, and Glasgow Coma Scale scores after dural damage and 6 months postoperatively in the two gro

探讨计算机三维钛网成形颅骨缺损修补术的临床应用价值。方法:回顾性分析我科2008年10月~2012年7月颅骨缺损使用钛网成形182例患者的临床资料。结果:182例患者术后均恢复良好,切口甲级愈合,无感染、皮下积液、硬膜外血肿及脑内血肿等并发症及不良反应。结论:使用计算机三维成形钛网作颅骨缺损成形材料效果满意、安全、并发症少。

Objective:To investigate the computer 3D titanium alloy mesh in cranioplasty clinical application value .Methods:The da-ta of 182 patients undergone titanium alloy cranioplasty from October 2008 to July 2012 , was analyzed by retrospective review .Results:182 patients recovered well ,incision healing,no infection,seroma,epidural hematoma and cerebral hematoma and other complications and adverse reactions.Conclusion:The utility of computer 3D titanium alloy mesh in clinical cranioplasty is convenient ,safe,effective and rare in complication .