脑外伤去骨瓣减压术后颅骨缺损修补手术时机的临床研究

Timing of Cranioplasty after Decompressive Craniectomy for Traumatic Brain Injury

目的:探讨颅脑外伤去骨瓣减压术后行颅骨缺损修补的最佳手术时机。方法:回顾性分析122例行颅骨修补手术患者的临床资料,比较行超早期、早期与延期颅骨修补术患者术后神经功能恢复、日常生活活动能力(activities of daily living,ADL)及并发症发生率情况,对颅骨修补手术时机的选择进行评价。结果:超早期组与早期组的神经功能恢复情况、并发症发生率及ADL评分无明显差异,延期组在远期神经功能恢复、ADLⅠ级情况等方面相较其他患者(包括超早期组与早期组)差。结论:对颅脑外伤去骨瓣减压术患者,超早期与早期颅骨修补的预后无明显差异,远期预后结果均优于延期修补。因此,早期行颅骨缺损修补有助于神经功能及ADL恢复,对部分条件许可的患者,可考虑行超早期颅骨修补。

Objective ：To investigate the optimal surgery time of skull defect repair after bone disc decompression in traumatic brain injury. Methods： 122 cases of traumatic skull defect were studied. The surgical results of the super early phase group, early phase group and deferred phase group were analyzed. And the neural function recovery, ADL and complications incidence of patients in three groups were observed to estimate the optimal time of skull repair surgery. Results： These were no significantly differences of ADL, complication, neural function recovery between super early phase group and early phase group. The patients in deferred phase group tend to have worse outcomes in ADL I and neural function recovery than other patients. Conclusions：For those patients with decompressive craniectomy for traumatic brain injury, restoration of neural function of super early phase group and early phase group was not significantly different. But the outcomes of deferred phase group were worse then other patients. Thus, there should be no hesitation in offering super early or early cranioplasty for those patients, who have the most to gain in terms of restoration of neural function.