双骨瓣技术在枕下乙状窦后入路中的应用研究

Clinical research of Dual Bone Flap Craniotomy via Suboccipital Retrosigmoid Approach

摘要:

目的 探索双骨瓣技术在枕下乙状窦后入路中的临床应用效果。方法 前瞻性纳入2021年8月至2022年10月郑大一附院神经外科行枕下乙状窦后入路手术治疗60例患者，随机分至双骨瓣组和单骨瓣组，每组各30例。结合术中术后资料，记录两组术中静脉窦损伤情况、术区骨质缺损大小、术后常见并发症情况。结果 双骨瓣组术区骨质缺损2-4.2mm，平均2.78mm；单骨瓣组术区骨质缺损4-11mm，平均7.78mm，两组间差异有统计学意义（P<0.001）。双骨瓣组术中乙状窦损伤1例，单骨瓣组术中乙状窦损伤3例。围手术期并发症：双骨瓣组1例伤口愈合不良、1例颅内感染；单骨瓣组1例皮下积液、2例颅内感染。结论 采取枕下乙状窦后双骨瓣开颅可有效减少骨质缺损和手术相关并发症，确保手术安全、高效进行，能取得满意的临床效果。

Abstract:

Objective To investigate the clinical research of dual bone flap craniotomy via the suboccipital retrosigmoid approach. Methods This prospective observational study enrolled 60 patients who underwent suboccipital retrosigmoid craniotomy at the Neurosurgery Department of The First Affiliated Hospital of Zhengzhou University from August 2021 to October 2022. Half of these patients were randomized into a dual bone flap (DBF) group, and the other half formed a single bone flap (SBF) group. Intraoperative venous sinus injury, the gap of the bone defect, and postoperative complications were documented according to all patients. Results The mean gap of bone defect was 2.78 mm (range, 2–4.2 mm) in the DBF group and 7.78 mm (range, 4–11 mm) in the SBF group, with?statistical?significance (t= -15.380, P < 0.001). There was one case of intraoperative venous sinus injury in the DBF group and three cases in the SBF group. Poor wound healing (n = 1) and intracranial infection (n = 1) were observed in the DBF group, while subcutaneous effusion (n = 1) and intracranial infection (n = 2) occurred in the SBF group. Conclusion Dual bone flap craniotomy via the suboccipital retrosigmoid approach can effectively reduce bone defects and operative complications, guarantee safety and efficiency, and produce ideal clinical outcomes.