目的 评估3D打印个体化穿刺导板辅助经皮微球囊压迫半月节治疗原发性三叉神经痛术中的准确性和疗效.方法 前瞻性研究2019年2月至2021年8月于我院治疗的35例原发性三叉神经痛患者,随机分为试验组和对照组,试验组18例,对照组17例.所有患者术前均行头颅CT薄层扫描,试验组采用3D打印个体化穿刺导板辅助经皮穿刺,对照组在移动C臂引导下徒手穿刺;记录所有患者穿刺针到位所用时间,术中穿刺针调整次数,术中球囊一次性成梨例数,术中移动C臂照射次数,记录患者术后并发症情况,术后BNI分级评分评估疗效.结果 与对照组相比,试验组穿刺到位所用时间、术中穿刺针调整次数及术中移动C臂照射次数均低于对照组(P<0.05),且术中球囊一次性成梨率明显高于对照组(P<0.05).根据BNI分级标准,两组患者术后治疗效果和并发症发生情况的差异无统计学意义(P>0.05),所有患者均未发生严重并发症.结论 3D打印个体化穿刺导板辅助经皮微球囊压迫半月节治疗原发性三叉神经痛手术,其精确度高,能有效提高穿刺成功率,缩短手术时间,降低手术风险,临床操作更简便、安全,值得向临床应用推广.

目的 分析优化手术流程在深低温保存钴-60灭菌自体颅骨修补颅骨缺损手术降低近期(1个月)并发症发生率的方法、优点及意义.方法 回顾性分析我院2018年10月～2020年10月收治的46例颅骨缺损病人的临床资料,全部采用深低温保存自体颅骨修补颅骨缺损.根据术前颅骨处理方式不同分为两组,实验组24例,采用80℃无菌生理盐水1000 ml+地塞米松20 mg复温30分钟;对照组22例,采用传统处理方式.结果 实验组皮下积液1例;对照组硬膜外血肿2例,皮下积液11例,其中严重皮下积液1例,颅骨感染1例(再手术).通过80℃无菌生理盐水+地塞米松20 mg复温30分钟,大大减少手术近期并发症,提升手术效果及病人舒适度.随访证实无骨瓣塌陷、无骨髓炎、无皮下积液.结论 改进颅骨处理方式能大大降低深低温保存自体颅骨修补颅骨缺损近期并发症.对于有条件开展自体颅骨修补的单位值得推荐,是一种简便、经济、安全、可行的方法.

Objective To evaluate the therapeutic effect of standard decompressive craniectomy combined with tentorial hiatus incision for severe traumatic brain injury (sTBI) to provide relevant evidence-based basis for treatment of sTBI. Methods The literatures were retrieved from PubMed, EMbase, Cochran, China National Knowledge Infrastructure (CNKI), China Biological Medicine Database (CBM-disc), VIP net and Wanfang data knowledge service platform, and the inclusion and exclusion criteria were set up for selecting the literatures. Jadad quality evaluation method was used to evaluate all the included literatures, and heterogeneity test was performed simultaneously. The patients receiving standard decompressive craniectomy with tentorial hiatus incision served as research group, and those receiving simple standard decompressive craniectomy as control group. Fixed effects model was appliedwhen several research results were identical, conversely, a random effects model used. Results Sixteen articles with 1142 patients were included in this research. Meta-analysis results showed that compared with the control group, the mortality was lower, the prognosis of 0 to 3 months, 3 to 6 months, 6 to 12 months were better, and the incidence rates of cerebral infarction, hydrocephalus and stress ulcer were also lower in the research group (P<0.01). Conclusions Simple standard decompressive craniectomy combined with tentorial hiatus incision can effectively improve the prognosis and reduce mortality and complications. But, the literatures included are less and limited to the domestic articles, and looking forward to more high quality and large sample research to validate it.