颅脑损伤去骨瓣减压术后早期颅骨成形对患者神经功能及远期预后的改善作用

Role of early cranioplasty after decompressive craniectomy surgery on neurological function improvement and long-term prognosis of patients with craniocerebral injury

目的探讨颅脑损伤去骨瓣减压术后早期颅骨成形对患者神经功能及远期预后的改善作用。方法选取徐州市中心医院2010年4月至2013年6月收治的37例颅脑外伤去骨瓣减压后遗留大面积颅骨缺损的患者作为研究组，研究组在去骨瓣减压术后早期（5～8周）进行颅骨成形术。颅脑损伤去骨瓣减压术后常规时间内（3～6个月）行颅骨成形的患者37例为对照组。术后采用神经功能缺损评分评价患者近期神经功能改善情况；术后随访1年，评价患者预后情况，并采用Fugl—Meyer量表评定患者肢体运动能力，采用Barthel指数评价患者日常生活能力。结果颅骨成形前两组神经功能缺损评分无明显差异，术后2、4周时研究组神经功能缺损评分明显低于对照组（P〈0．05）。术后4周，研究组颅骨缺损综合征发生率明显低于对照组（P〈0．05）。术后1年，研究组恢复良好患者比例明显高于对照组，重度残疾患者比例明显低于对照组（P〈0．05）；研究组Fugl—Meyer、Barthel评分明显高于对照组，差异有统计学意义（P〈0．05）。结论颅脑损伤去骨瓣减压患者早期行颅脑成形术可促进患者近期神经功能恢复，减少颅骨缺损相关并发症，对提高患者远期运动、生活能力、改善预后有积极作用。

Objective To investigate the role of early cranioplasty after decompressive craniectomy surgery on the neurological func- tion improvement and long-term prognosis of patients with craniocerebral injury. Methods Thirty-seven patients underwent decompressive craniectomy surgery due to craniocerebral injury in our hospital were selected, and given early cranioplasty in 5 -8 weeks after decompressive craniectomy. And 37 patients given conventional cranioplasty in 3 -6 months after decompressive craniectomy were randomly selected as con- trol group. After cranioplasty, score of neurological deficits was used to evaluate neurological function, all patients were followed up for 1 year in order to evaluate the prognosis of patients, and the Fugl-Meyer scale was used to evaluate physical exercise capacity of patients, and Bar- thel index （Barthel） was used to evaluate daily living activities of patients. Results Before cranioplasty, neurological deficit score of the two groups was not significantly different, but the neurological deficit scores of study group in 2 and 4 weeks after surgery were significantly lower than those of the control （P 〈 0.05）. Four weeks after cranioplasty, the incidence of skull defect syndrome in study group was significantly lower than in the control group （ P 〈 0.05 ）. One year after cranioplasty, good recovery proportion of the study group was significantly higher than that of the control, and severe disability proportion was significantly lower than that of the control group （P 〈 0.05 ） ; Fugl-Meyer, Bar- thel scores were significantly higher than those of the control group, and the difference was statistically significant （ P 〈 0.05 ）. Conclusion In patients with craniocerebral injury, early cranioplasty after decompressive craniectomy surgery can promote recent neurological function re- covery, reduce skull defect-related complications, and has positive effect in improving patients＇long -term exercise capacity, daily living ac- tivities and prognosis outcome.