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目的采用SPECT-CT研究颅骨成形术对脑血流灌注的影响。方法19例重型颅脑损伤病人在标准大骨瓣减压术后3个月行颅骨成形术。术前2d及术后10d行SPECT-CT检查,SPECT-CT检查当天及术后1个月行神经功能评价,分析手术前后伤侧及对侧海马、皮质、丘脑的脑血流灌注值。结果颅骨成形术前后病人神经功能评价差异无统计学意义。SPECT-CT脑血流灌注显像提示对侧运动感觉皮质、海马、丘脑脑血流量在颅骨成形术前后未见显著差异。伤侧运动感觉皮质脑血流量在颅骨成形术后明显增加(P<0.05),与对侧比较无显著差异。伤侧丘脑脑血流量在颅骨成形术后明显增加(P<0.05),但仍低于对侧。伤侧海马脑血流量在颅骨成形术后无显著变化,但低于对侧检测值。结论颅骨成形术可显著改善伤侧皮质及丘脑血流灌注状况。
Objective To study the effect of skulloplasty on cerebral perfusion by SPECT-CT. Methods Nineteen patients with severe traumatic brain injury underwent cranioplasty at 3 months after standard decompressive craniectomy. The neurological function was evaluated on the day 2 and the day after surgery by SPECT-CT, 2 days before operation and 10 days after operation. The cerebral perfusion values in injured and contralateral hippocampus, cortex and thalamus before and after operation were analyzed. Results There was no significant difference in neurological function between before and after cranioplasty. SPECT-CT perfusion imaging showed that there was no significant difference in cerebral blood flow in cortex, hippocampus and thalamus before and after cranioplasty. Stroke-sensory cortical cerebral blood flow increased significantly after cranioplasty (P <0.05), but not significantly different from contralateral. Injury of thalamic cerebral blood flow after cranioplasty was significantly increased (P <0.05), but still lower than the contralateral. There was no significant change in cerebral blood flow in injured side hippocampus after cranioplasty, but lower than the contralateral value. Conclusion Skull angioplasty can significantly improve the blood flow of injured cortex and thalamus.