超早期三维钛网颅骨修补术的临床研究

Ultra Craniectomy Early Clinical Study Three-dimensional Titanium Mesh Skull Repair Surgery Reduced Pressure

目的:探讨重型颅脑损伤去骨瓣减压手术后颅骨缺损在超早期(4~6周内)行三维钛网颅骨修补的可行性和对患者长期预后的影响,探讨超早期颅骨修补术手术中是否较常规手术存在优势。方法:回顾性分析自2012年1月-2015年1月行颅脑损伤后颅骨缺损手术修补患者99例。将所有患者根据去骨瓣减压术后行颅骨修补的间隔时间分为两组,4-6周以内为超早期组,共52例,3-6个月为常规组,共47例。采用不同国际评分标准比较两组患者在颅骨修补术后1个月、3个月、12个月的生存质量;对比分析两组患者的术中头皮剥离时间及术中出血量;比较两组患者术后1个月、3个月、12个月相应并发症的差异。结果:超早期组患者术后1个月的格拉斯哥评分(Glasgow outcome scale,GOS)、美国国立卫生院神经功能缺损评分(NIHSS)和远期卡氏功能状态(Karnofsky performance status,KPS)评分较常规组比较无统计学意义(P>0.05);超早期组患者术后3个月和12个月的GOS、NIHSS和KPS评分较常规组均有显著提高(P<0.05)。超早期组患者头皮剥离时间较常规修补组明显缩短(P<0.05),出血量明显减少(P<0.05);两组颅骨修补术后硬膜下积液发生率明显降低,差异有统计学意义(P<0.05),然而总体并发症发生率并无明显差异(P>0.05)。结论:重度颅脑损伤去骨瓣减压术后患者在超早期(4~6周内)行颅骨修补在临床上是安全有效的,能够改善患者的预后和减少术后并发症的发生概率,并且能够减少术中出血,手术中头皮剥离时间也有缩短。

Objective：To investigate the severe brain injury after decompressive surgery of skull defects ultra-early （4-6 weeks） the feasibility of row three-dimensional titanium mesh skull patch and its impact on the long-term prognosis of patients,and to explore ultra-early skull repair surgery Are compared with conventional surgery exist advantages.Methods：A retrospective analysis from January 2012-January 2015 after the Brain Injury skull defect repair surgery 99 patients all patients after decompression interval skull patch into two groups according to craniectomy,4.within-6 weeks for ultra-early group,52 cases,3-6 months for the conventional group,47 cases.Skull patch after 1 month,3 months,quality of life between the two groups of patients with different international scoring 12 months;comparative analysis peeling scalp surgery time and blood loss between the two groups;two groups were compared after 1 month,3 months,12 months,corresponding to the difference complications.Results：Ultra-early group patients after one month of GCS （Glasgow outcome scale,GOS）,the US National Institutes of Health neurological deficits （NIHSS） and long-term Karnofsky functional status （Kamofsky performance status,KPS） score compared with the conventional group no significant difference （P〉0.05）;super-early group patients 3 months and 12 months ofGOS,NIHSS and KPS scores were significantly increased （P〈0.05） than the conventional group.Patients with ultra-early scalp skull patch set release time than conventional repair group was significantly shorter （P〈0.05）,the amount of bleeding was significantly reduced （P〈0.05）;the next two cranioplasty subdural effusion were significantly lower,the difference statistics significance （P〈0.05）.However,the overall complication rate was no significant difference （P〉0.05）.Conclusion：Severe brain injury patients after decompression eraniectomy in the ultra-early （4-6 weeks） skull patch is clinically safe and effective,it can improve patient outcomes and reduce the probability of occurrence of postoperative complications,and can reduce blood loss during surgery scalp peeling time shortened.