重型颅脑损伤后行超早期修复颅骨缺损对患者预后的影响临床研究

A Clinical Study on the Prognosis of Patients with Skull Defects after Severe Craniocerebral Injury by Super Early Cranial Repair

目的本研究旨在比较超早期修复与常规修复的功能预后状况。方法对2017年1月至2020年1月招募的120例重症颅脑外伤术后行颅骨成形术的患者进行前瞻性研究。依据颅脑损伤术后颅骨成形修复时间分为超早期组(术后4~6周修复,56例)和常规组(术后3~6个月修复,64例)。记录临床资料:性别、年龄、GOS评分、四肢痉挛、意识丧失、偏瘫、失语症,进行单因素Logistic分析。结果GOS评分(P=0.003)、四肢痉挛(P=0.002)、意识丧失(P<0.001)、偏瘫(P=0.009)、失语(P=0.007)与重症颅脑外伤术后行颅骨成形术的时间具有显著相关性。超早期治疗与GOS评分(P=0.031)、四肢痉挛(P=0.003)、意识丧失(P=0.002)、偏瘫(P=0.002)和失语症(P=0.010)有明确相关性。结论超早期颅骨修复可改善患者术后GOS评分、四肢痉挛、意识丧失、偏瘫、失语症,改善患者的神经缺损状态、生活能力和预后。

Aim Craniocerebral injury has a high disability and mortality rate.The choice of the appropriate timing of cranioplasty has a very important impact on the prognosis of patients.The function prognosis status between super early repair and conventional repair were compared.Methods A total of 120 patients who underwent cranioplasty surgery after severe craniocerebral trauma surgery of a prospective study from January 2017 to January 2020.All patients were divided into two groups according to the time of cranial repair after the operation of craniocerebral injury:a super early group(4-6 weeks after the operation,56 cases)and a regular group(3-6 months after the operation,64 cases).Sex,age,GOS score,limbs convulsion,loss of consciousness,hemiplegia,and aphasia were recorded.Univariate Logistic analysis was performed.Results GOS score(P=0.003),limbs convulsion(P=0.002),loss of consciousness(P<0.001),emiplegia(P=0.009)and aphasia(P=0.007)were significantly related to the intervention period of cranioplasty after severe craniocerebral injury.And GOS score(P=0.031),limbs convulsion(P=0.003),loss of consciousness(P=0.002),hemiplegia(P=0.002)and aphasia(P=0.010)have a clear correlation with whether the patients have super early treatment.Conclusion Super early cranial repair could improve postoperative GOS score,limbs convulsion,loss of consciousness,hemiplegia,and aphasia.The state of nerve defect,living ability,and prognosis of patients can be also effectively improved.