重型颅脑外伤去骨瓣减压术后早期颅骨成形术对患者早期、远期影响研究

Study on short term and long-term effects of early cranioplasty after decompressive craniectomy in patients with severe traumatic brain injury

目的探讨重型颅脑外伤去骨瓣减压术后早期颅骨成形术对患者神经功能康复及预后的影响。方法选择2009年1月至2011年1月收治的重型颅脑损伤患者48例进行回顾性分析。根据治疗方法不同,其中25例在术后早期进行颅骨缺成形术的(研究组),另23例患者常规术后3～6个月进行颅骨缺成形术(对照组)。结果两组患者颅骨成形术前、术后2周神经功能缺损评分、Barthel指数、Fugl-meyer评分差异无统计学意义,术后4周研究组各指标均优于对照组,组间差异有统计学意义。研究组患者成形术后2、12个月的生活质量评分均明显高于对照组,差异有统计学意义。术后2个月研究组颅骨缺损综合征及硬膜下积液明显少于对照组。两组患者均存活,无死亡病例。结论重型颅脑外伤去骨瓣减压术安全有效,值得推广。

Objective To study the short term and long-term effects of early cranioplasty after decompressive craniectomy in patients with severe traumatic brain injury.Methods The clinical data of 48 patients with severe craniocerebral injury admitted in this hospital during January 2009 to January 2011 were retrospectively analyzed.According to the procedures of surgery,skull missing cranioplasty had been performed in 25 patients at early postoperative period（study group）,and skull missing cranioplasty had been performed in remaining 23 patients at 3 to 6 months after conventional surgical treatment（control group）.Results The difference in neurological deficit scores,Barthel index and Fugl-meyer scores in patients at 2 weeks after cranioplasty between these two groups was statistically significant,and indicators of patients in study group after 4 weeks of surgery were better than those of patients in control group,the difference between these 2 groups was statistically significant.The scores in quality of life of patients in study group at 2 and 12 months after the operation were significantly higher than those of patients in control group,and their difference was statistically significant.The occurrence of skull defect syndrome and subdural effusion in patients of study group 2 months after the operation was significantly less than those of patients in control group.All patients in both groups were alive with no death.Conclusion The application of bone flap decompression operation in treatment of severe traumatic brain injury is safe and effective,hence it is worthy to be recommended.