[1]秦海林　秦　汉　安学锋.成人头颅骨模型模拟去骨瓣减压术后颅内压变化[J].中国临床神经外科杂志,2018,(11):735-738.[doi:10.13798/j.issn.1009-153X.2017.11.010]
　QIN Hai-lin,QIN Han,AN Xue-feng..Relationship between intracranial pressure and area of bone flap after imitating craniectomy in adult skull model[J].,2018,(11):735-738.[doi:10.13798/j.issn.1009-153X.2017.11.010]
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成人头颅骨模型模拟去骨瓣减压术后颅内压变化()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2018年11期
页码:
735-738
栏目:
论著
出版日期:
2018-11-25

文章信息/Info

Title:
Relationship between intracranial pressure and area of bone flap after imitating craniectomy in adult skull model
作者:
秦海林　秦　汉　安学锋
430070 武汉，中国人民解放军武汉总医院神经外科（秦海林、秦　汉、安学锋）
Author(s):
QIN Hai-lin;  QIN Han;  AN Xue-feng.
Department of Neurosurgery, Wuhan General Hospital, PLA, Wuhan 430070, China
关键词:
去骨瓣减压术; 颅内压; 代偿容积; 骨瓣面积; 压力-容积曲线
Keywords:
Decompressive craniectomy;  Intracranial pressure;  Frontotemporoparietl bone flap area;  Relationship
分类号:
R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2017.11.010
文献标志码:
A
摘要:
目的 了解去骨瓣减压术对颅内压及颅腔顺应性的影响。方法 以正常成年男性尸头颅数据制作一个密闭颅腔模型及颅内压研究模型，按骨瓣位置、初始颅内压及骨瓣面积分组，测定模拟去骨瓣减压术前后压力，分析骨瓣面积与降压效果的关系。结果 颅内压升高至30 mmHg以上，随着骨瓣面积增大可逐渐降至基础压力，降压效果与骨瓣面积呈正相关（r=0.99，95% CI 0.98~0.99；P<0.001）。两者线性回归方程为y=81.07+0.79b（y为代偿容积，b为骨瓣面积），截距a 95% CI：77.78~84.36（P<0.001），回归系数b 95% CI 0.73~0.85（P<0.001）；决定系数R2=0.99。结论 去骨瓣减压术能迅速有效降低颅内压，降压效果与骨瓣面积正相关。
Abstract:
Objective To understand the impact of size of bone flap of frontotemporoparietl craniectomy on intracranial pressure (ICP) and cranial cavity compliance. Methods The closed cranial cavity models were made based on the data of cadaveric heads of normal adult men. The craniectomy was imitated on the models. ICP was measured before and after the different areas of frontotemporoparietl bone flaps removed by the craniectomy. The relationship of the removed flap area with ICP was analyzed. Results When ICP increases to over 30 mmHg, ICP will gradually drop to baseline pressure with the bone flap area increases. The antihypertensive effect was positively related with the bone flap area (r=0.99, 95% CI 0.98~1.00; P<0.001). The linearity regress equation was y=81.07+0.79 b (y: compensatory volume and b: bone flap area). 95% CI: the intercept a was 77.78~84.36 (P<0.001), the regression coefficient b was 0.73~0.85 (P<0.001), and the determination coefficient was R2=0.99. Conclusions Bone flap removal can rapidly decrease ICP. The antihypertensive effect is positively related with removed frontotemporoparietl bone flap area.

参考文献/References:


[1] Kim JH, Yun SH, Jang KH, et al. Delayed and prolonged local brain hypothermia combined with decompressive craniectomy: a novel therapeutic strategy that modulates glial dynamics [J]. Exp Neurobiol, 2014, 23(2): 115-123.
[2] Khan F, Valliani A, Rehman A, et al. Factors affecting func- tional outcome after decompressive craniectomy performed for traumatic brain injury: a retrospective, cross-sectional study [J]. Asian J Neurosurg, 2018, 13(3): 730-736.
[3] Avital S, Brasesco O, Basu A, et al. Effects of colonoscopy on intracranial pressure: observation in a large animal model[J]. Endoscopy, 2004, 36(11): 997-1000.
[4] Blaha M, Schwab J, Vajnerova O, et al. Intracranial pressure and experimental model of diffuse brain injury in rats [J]. J Korean Neurosurg Soc, 2010, 47(1): 7-10.
[5] Aboy M, McNames J, Hornero R, et al. A novel statistical model for simulation of arterial and intracranial pressure [C]. Conf Proc IEEE Eng Med Biol Soc, 2004, 1: 129-132.
[6] Benabid AL, de Rougemont J, Barge M. Intracranial pres- sure: II. Experimental verification of a mathematical model [J]. J Physiol (Paris), 1975, 70(1): 41-59.
[7] Gaohua L, Kimura H. A mathematical model of intracranial pressure dynamics for brain hypothermia treatment [J]. J Theor Biol, 2006, 238(4): 882-900.
[8] Schmidt B, Czosnyka M, Schwarze JJ, et al. Evaluation of a method for noninvasive intracranial pressure assessment during infusion studies in patients with hydrocephalus [J]. J Neurosurg, 2000, 92(5): 793-800.
[9] Schmidt B, Czosnyka M, Raabe A, et al. Adaptive noninva- sive assessment of intracranial pressure and cerebral auto- regulation [J]. Stroke, 2003, 34(1): 84-89.
[10] Whitmore RG, Thawani JP, Grady MS, et al. Is aggressive treatment of traumatic brain injury cost-effective [J]? J Neurosurg, 2012, 116(5): 1106-1113.
[11] Rossi-Mossuti F, Fisch U, Schoettker P, et al. Surgical treatment of severe traumatic brain injury in Switzerland: results from a multicenter study [J]. J Neurol Surg A Cent Eur Neurosurg, 2016, 77(1): 36-45.
[12] Hutchinson PJ, Kolias AG, Timofeev IS, et al. Trial of de- compressive craniectomy for traumatic intracranial hyper- tension [J]. N Engl J Med, 2016, 375(12): 1119-1130.
[13] Moon JW, Hyun DK. Decompressive craniectomy in trauma- tic brain injury[J]. Korean J Neurotrauma, 2017, 13(1): 1-8.
[14] de Quintana-Schmidt C, Clavel-Laria P, Asencio-Cortes C, et al. Sinking skin flap syndrome [J]. Rev Neurol, 2011, 52 (11): 661-664.
[15] De Bonis P, Pompucci A, Mangiola A, et al. Post-traumatic hydrocephalus after decompressive craniectomy: an undere- stimated risk factor [J]. J Neurotrauma, 2010, 27(11): 1965- 1970.
[16] Moskowitz E, Melendez CI, Dunn J, et al. Long-term effects of decompressive craniectomy on functional outcomes after traumatic brain injury: a multicenter study [J]. Am Surg, 2018, 84(8): 1314-1318.
[17] Skoglund TS, Eriksson-Ritzén C, Jensen C, et al. Aspects on decompressive craniectomy in patients with traumatic head injuries [J]. J Neurotrauma, 2006, 23(10): 1502-1509.

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更新日期/Last Update: 2018-11-20