颅骨修补对重型颅脑损伤术后意识恢复的影响

Effect of cranioplasty on the consciousness recovery after severe brain injury

目的 探讨颅骨修补对重型脑外伤去骨瓣减压术后长期昏迷病人的影响.方法将47例重型脑外伤去骨瓣减压术后3个月内未清醒（GSC≤8）病人分2组：颅骨修补组20例,对照组27例.颅骨修补组在颅骨修补术后第3个月和第6个月分别进行GOS评分,对照组在对应时间进行随访评估,评估分为有效（GOS 3～5）,无效（GOS=2）,死亡（GOS=1）.结果 颅骨修补组总有效率高于对照组（P＜0.05）;2组病死率比较无明显差异（P＞0.05）.颅骨修补组修补术后第6个月评估,去骨瓣术前一侧瞳孔散大病人有效率高于两侧瞳孔散大病人（P＜0.05）,两侧颅骨缺损有效率高于一侧颅骨缺损病人（P＜0.05）,术前GCS评分高的病人有效率高于GCS评分低的病人（P＜0.05）;性别和修补材料对预后的影响差异无统计学意义（P＞0.05）.结论颅骨修补有利于脑外伤术后长期昏迷病人的清醒.

Objective To study the effect of cranioplasty patients in long-term coma in severe brain injury after decompressive Craniectomy. Methods Totally 47 cases of severe traumatic brain injury after decompressive craniectomy （GSC;8） were divided into two groups, cranioplasty group （n= 20） and control group （n = 27）. Outcome was evaluated by Glasgow outcome scale at 3 and 6 months after cranioplasty in the cranioplasty group, and the control group was evaluated at corresponding time. The assessment was divided into effective （GOS 3-5）, invalid （GOS 2）, death （GOS 1）. Results The total efficiency in cranioplasty group was higher than that of the control group （P〈0.05）, and there was no significant difference between the two groups in term of mortality （P〉0.05）. In cranioplasty group, the effective rate of unilateral corectasis patients was higher than that of bilateral corectasis patients at sixth month after cranioplasty, and bilateral skull defect effective rate was higher than unilateral skull defect patients, and effective rate of high preoperative GCS score of patients is higher than that of low GCS score of patients （P〈0.05）. In the aspect of sex of the patient and the use of material, there were no significant differences in the prognosis （P〉0.05）. Conclusion Cranioplasty is beneficial to severe brain injury patients with prolonged coma to recover consciousness.