Early Cranioplasty And Ventriculo-peritoneal Shunt Effect And Feasibility In Treatment Of Brain Injury

Objective:To investigate the effect of early cranioplasty and ventriculo-peritoneal shunt therapy for traumatic brain injury in patients with clinical efficacy of, and evaluation of the operation scheme is applied to the treatment of traumatic brain injury related factors of safety and feasibility, and analysis of influence of cranioplasty complications. Method:select2008January to2012January in our hospital department of neurosurgery in hospital patients with skull defect72cases required ventriculoperitoneal shunt for treatment as the object of study, in accordance with the skull repair operation time is divided into A group and B group. The A group adopted ventriculo-peritoneal shunt with early (within2months) skull neoplasty,40cases; group B took first ventriculoperitoneal shunt, then cranioplasty after2months, a total of32cases of patients. For June to1years of follow-up of two groups of patients with Glasgow Coma Scale (GCS), the degree of coma score system evaluation of two groups of patients with postoperative; evaluation of two groups of patients daily life ability by Barthel index; evaluation by Fugl-Meyer method, two groups of patients with limb movement function and nerve defect degree, record the data and make comparison. In addition, to observe the two groups of patients with complications, and analysed the complications. Results:(1) the A group underwent early cranioplasty can easily free skin flap, the average operation time was95.34±4.73min, the average time of free flap was15.4±1.25min, average intraoperative bleeding was336.68±24.73ml; group B received late cranioplasty, the average operation time was133.68±5.14min, the average time of free skin flap is40.68±3.12min, the average intraoperative bleeding volume was574.32±26.59ml, there were significant difference between the two groups of patients with the index (P<0.01).(2)36cases of good recovery A group patients (90%), moderate disability in4cases (10%), severe disability in0cases (0%);22cases of good recovery after operation in B group (68.75%), moderate disability in5cases (15.63%), severe disability in5cases (15.63%), no death case two group operation, two groups of recovery is more difference was not statistically significant (P>0.05).(3) before surgery, GCS scores of the two groups were not statistically significant (P>0.05), postoperative and follow-up period in A group was significantly better than that in B GCS group (P<0.05); the two groups of patients with ADL, limb movement function and neural function compared with preoperative have a certain degree of recovery (P<0.05), but the A group were significantly higher than those in B group (P<0.05).(4) of1cases in group B with shunt tube obstruction,3cases had infection, subcutaneous effusion in2cases, intracranial hematoma in1cases, scalp necrosis in1cases,2cases of cerebrospinal fluid leakage, the complication rate was31.25%; while in A group no intraoperative shunt obstruction,2cases had infection,1cases of subcutaneous effusion, without the occurrence of cerebral spinal fluid leakage, scalp necrosis, repair material exposed, cranial flap repair material absorption, the collapse displacement, the complication rate was7.50%, the difference between the two groups was statistically significant (X2=6.78, P<0.05).(5) the age of the patients and the defect degree are main factors causing complications in elderly patients, complication rate was significantly higher than that in young patients (P<0.05), the damage area of complications in patients with high incidence was significantly higher than that of injury in patients with small area (P<0.05). Conclusion:for patients with traumatic brain injury, early cranioplasty and ventriculoperitoneal shunt operation, not only to meet the requirements of patients with beautiful appearance, but also improve the quality of life effectively, and can effectively promote the brain regional blood flow recovery, prevention of brain tissue defect again injury, and restore and improve the neurological function. Effect of the operation scheme is satisfied, the low rate of complications, the main influencing factors were age and the size of the defect. Therefore, development of cranioplasty combined with ventriculoperitoneal shunt for the treatment of traumatic brain injury in early stage is an effective and safe treatment, worthy of further promotion and application in clinical practice.