开颅术后颅骨缺损修补时机的选择

Opportunity choice of cranioplasty for skull defect after craniectomy

目的 探讨开颅术后颅骨缺损修补的最佳时机.方法 将2004年1月至2013年1月192例开颅术后颅骨缺损患者根据骨窗塌陷深度（D值）的不同分为三组,即：轻度塌陷组67例（D＜ lcm）、中度塌陷组70例（1 cm≤D＜2cm）、重度塌陷组55例（D≥2 cm）.手术时间＜3个月者112例,3～6个月者74例,＞6个月者6例.比较各组患者神经功能改善情况.结果 192例患者术后神经功能改善127例,改善率为66.1％.轻、中、重度塌陷组改善率分别为73.1％（49例）、74.3％（52例）、47.3％（26例）,轻、中度塌陷组神经功能改善率高于重度塌陷组.结论 依据开颅术后骨窗的塌陷程度早期行颅骨缺损修补治疗,可早期改善患者神经功能、提高生活质量.

Objective To study the operative opportunity of cranioplasty for skull derect after craniectomy.Methods From January 2004 to January 2013,192 cases of skull defect were divided into three groups,according to the degree of umbilication of decompression window （D）：light umbilication group（n =67,D 〈 1 cm）,midrange group（n =70,1 cm≤D 〈2 cm）,severe umbilication group（n =55,D ≥2 cm）.A total of 112 cases took cranioplasty within 3 months after craniectomy,74 cases within 3 to 6 months,6 cases took cranioplasty after 6 months.The changes of neural function after operation were compared.Results One hundred and twenty-seven cases benefited in neural function,the rate was 66.1%.The benefited rates of light,midrange,severe umbilication group was 73.1% （49 cases）,74.3%（52 cases） and 47.3 % （26 cases） respectively.The light and midrange umbilication group took better neural function improvement than that in severe umbilication group.Conclusions Take degree of umbilication of decompression window as evidence for operative opportunity of cranioplasty is reliable.Cranioplasty need to be taken as early as possible to improve neural function and quality of life.