早期颅骨缺损修补术的效果及安全性研究

Efficacy and Safety of Early Cranioplasty

目的评价早期颅骨修补术的安全性和有效性。方法因颅脑外伤导致难治性颅高压于2006年1月～2011年6月在我科行去大骨瓣减压术90例,其中早期行颅骨修补术60例(早期修补组),行颅骨修补术的时间间隔去大骨瓣减压术38.2(36～40)d;另30例在大骨瓣减压术后3个月行颅骨修补术(对照组),行颅骨修补术的时间间隔去大骨瓣减压术107.6(90～153)d。通过分析手术耗时、皮瓣游离时间、手术失血量及并发症来回顾性研究两组的临床效果,评估早期颅骨修补的有效性。结果早期修补组的手术总时间比对照组明显缩短,为(95.33±4.71)min vs.(133.67±5.12)min,皮瓣游离时间明显缩短,为(15.3±1.24)min vs.(40.67±3.11)min,手术总出血量明显减少,为(336.67±24.6)mlvs.(573.30±26.7)ml(P<0.01)。两组术后伤口感染率无明显差别,但早期修补组的硬膜下积液率及皮瓣游离过程中硬膜破裂率明显少于对照组,分别为6.7%(4/60)vs.30%(9/30)和3.3%(2/60)vs.26.7%(8/30)(P<0.01)。结论早期颅骨修补手术,能够在手术操作过程中更好地进行软组织分离,减少出血,同时也不会增加手术带来的包括感染、硬膜下积液及硬膜破裂甚至脑实质损伤等并发症。

Objective To evaluate the efficacy and safety of early cranioplasty performed 40 days after the first surgical decompression. Methods 90 patients were retrospectively enrolled from January 2006 to June 2011. All primary causes for cranieetomy were traumatic refractory intracranial hypertension. There were 60 eases received early cranioplasty 38.2 （ 36 - 40 ） days after cranieetomy. And there were 30 eases received late cranioplasty 107.6 （90 ~ 153 ）days after craniectomy. The efficacy of early cranioplasty was assessed by measuring elapsed operating time, dissection time, and blood loss comparing with the late cranioplasty group. Results The mean time for flap dissection of the early cranioplasty group was shorter,which was （15.3 ± 1.24） min vs. （40.67± 3.11 ）min （P 〈 0. O1 ）. And the estimated blood loss was less, （336.67 ± 24.6）ml vs. （ 573.30：1：26.7 ） ml（ P 〈 0.01 ）. There was no statistic significance between two groups in terms of postoperative infections. The incidences were decreased in early group in contrast to the control group of the postoperative subdural fluid collection and the putamen rupture during the flap dissociation. Conclusions Early cranioplasty provides satisfactory securing dissection plane during operative procedures compared with the late cranioplasty, without causing additional complications including infection, subdural hygroma, and brain parenchymal damage for selected cases.