颅骨成形术对脑血流灌注的影响：SPECT—CT显像观察

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。

Effect of cranioplasty on cerebral blood infusion: evaluation with SPECT-CT

Objective To investigate the effects of cranioplasty on cerebral blood infusion （CBI） with SPECT-CT. Methods Nineteen patients with severe traumatic brain injury underwent standard decompressive craniectomy, then received cranioplasty 3 months later. The measurements of cerebral blood flow with SPECT-CT were obtained 2 days before and 10 days after cranioplasty. The neurofunction was evaluated immediately after SPECT-CT examination and 1 month after cranioplasty. The cerebral blood flow was analyzed at the injured side and contralateral hippocampus, cortex, thalamus before and after the operation respectively. Results There was no significant difference in neurofimction before and after cranioplasty. No significant change of CBI was observed on the motor sensory cortex, hippocampus and thalamus at contralateral side before and after cranioplasty. The CBI of motor sensory cortex at injured side was significantly increased （P 〈 0.05） after cranioplasty, while there was no difference with that at the normal side. The CBI of thalamus at injured side was also increased after operation （P 〈 0.05）, while still lower than that at the normal side. The CBI of hippocampus at injured side had no significant change after the operation, while still lower than that at contralateral side. Conclusion Cranioplasty could be beneficial to the recovery of traumatic brain injury through elevating the cerebral blood perfusion.