去骨瓣减压术后早期颅骨修补术对患者预后的影响

Effect of Early Cranioplasty on Prognosis after Decompressive Craniectomy

目的分析颅脑损伤后去骨瓣减压术后早期颅骨修补对患者长期功能预后的影响。方法采用回顾性病例对照研究的方法 ,比较颅脑损伤去骨瓣减压术后行早期的颅骨修补术(<2个月)患者与术后行常规颅骨修补术(>3个月)患者长期预后的差异,从而评价早期颅骨修补对于颅脑损伤行去骨瓣减压术患者的预后影响。早期颅骨修补组与延期颅骨修补组各23例,病例根据性别、年龄、颅脑损伤的严重程度及修补术前预后水平1∶1配对。结果比较外伤后15个月患者的预后水平,早期颅骨修补组(GOS:4.3±0.9;KPS:73.9±22.5)较延期颅骨修补组(GOS:3.8±1.0;KPS:62.6±24.2)有显著提高。结论在掌握适应证的情况下去骨瓣减压术后早期的颅骨修补术对患者预后的改善安全有效。

Objective To analyze whether early cranioplasty improves the outcomes in patients with large cranial defects resulting from decompressive surgery after severe head trauma. Methods A case control cohort study was performed to compare the outcomes of the patients who underwent early cranioplasty ranged from 5 to 8 weeks（ 〈2 months） after decompressive craniectomy due to severe brain injury with those of the patients who underwent routine cranioplasty. The data of age, gender and severity of the head trauma were well compared between early cranioplasty group and delayed cranioplasty group. Results 15 months after head trauma,the prognosis of the early cranioplasty group （GOS：4.3 ± 0.9;KPS：73.9 ± 22.5）was better than that of the delayed cranioplasty group（GOS：3.8 ± 1.0;KPS：62.6 ± 24.2）,with a significant difference. Conclusion Early cranioplaty for large cranial defects by decompressive craniectomy is safe and helpful to improve the prognosis, and may contribute to better outcomes compared with late cranioplasty.