人工硬膜减张缝合关闭硬脑膜对去骨瓣减压颅脑创伤患者的脑保护作用

Tension-reduced suture of dura mater with artificial dura for cerebral protection following decompressive craniectomy of craniocerebral trauma

目的 探讨采用人工硬膜减张缝合关闭硬脑膜对去骨瓣减压颅脑创伤患者的脑保护作用. 方法 回顾性分析因颅脑创伤单侧标准外伤大骨瓣减压后行人工硬膜关闭硬脑膜（研究组52例）和未行硬脑膜关闭（对照组46例）患者的临床资料,比较两组术后CT影像、ICU住院天数、伤后12个月的格拉斯哥预后评分（GOS）、癫痫发生率、肢体瘫痪、巴塞尔指数（BI）、简易精神状态检查（M MSE）等参数. 结果 两组术后病程中CT影像减压窗区脑膨出后脑梗死发生率分别为4％（2/52）和22％ （10/46） （P ＜0.05）.研究组恢复良好率、重残率分别为33％（17/52）、10％ （5/52）,对照组分别为15％（7/46）、26％ （12/46） （P ＜0.05）.研究组病死率及生存患者癫痫发生率分别为19％（10/52）、19％（8/42）,对照组分别为22％ （10/46）、19％ （7/36）（P ＞0.05）.研究组生存患者ICU住院天数、肌力Ⅲ级以下的肢体瘫痪发生率、BI、MMSE分别为（8.7±4.3）d、10％（4/42）、（73.9±18.9）分、（23.5±7.0）分,对照组分别为（12.2-7.2）d、31％（11/36）、（51.6±21.8）分、（19.2±6.9）分（P＜0.05）. 结论 采用人工硬膜减张缝合关闭硬脑膜能改善颅脑创伤后去骨瓣减压患者的日常活动能力及认知功能,有重要的脑保护作用.

Objective To investigate the brain protection of tension suture of dura-mater with artificial dura after decompressive craniectomy in craniocerebral trauma.Methods The study retrospectively analyzed craniocerebral trauma patients managed with standard decompressive craniectomy in the presence （study group,n =52） or absence of dura mater close （control group,n =46）.Clinical data,such as postoperative CT images,days of stay in ICU,Glasgow Outcome Scale （GOS） 12 months after injury,morbidity of epilepsy,acroparalysis,Barthel index （BI） and mini-mental status examination （MMSE） were analyzed and compared between the two groups.Results Occurrence rates of combined encephalocele and cerebral infarction around skull windows according to post-operative CT scan were 4% （2/52） in study group and 22% （10/46） in control group （P 〈0.05）.Ratios for good-recovery （GOS =5） and severe disability （GOS =3） were respectively 33% （17/52） and 10% （5/52） in study group,and they were 15% （7/46） and 26% （12/46） in control group （P 〈0.05）.For study and control groups mortality [19% （10/52） vs 22% （10/46）] and epilepsy ratio among the survivors [19% （8/42） vs 19% （7/36）] were comparable （P 〉 0.05）,but days of stay in ICU [（8.7 ± 4.3） d vs （12.2 ±7.2） d],acroparalysis （myodynamia 〈 grade Ⅲ） [10% （4/42） vs 31% （11/36）],BI [（73.9±18.9） vs （51.6±21.8）] and MMSE [（23.5 ±7.0） vs （19.2 ±6.9）] were significantly different （P 〈 0.05）.Conclusion To close the dura-mater by tension-reduced suture with artificial dura suggests a good protective effect on brain function,for it improves the daily activity capabilities and cognitive function in craniocerebral trauma patients treated with decompressive craniectomy.