颅骨成形术对颅内动脉瘤夹闭同期去骨瓣减压患者预后的影响

Effect of cranioplasty on prognosis of patients accepted intracranial aneurysm clipping combined with simultaneous decompressive craniectomy

目的探讨颅骨成形术对颅内动脉瘤夹闭同期去骨瓣减压患者预后的影响。方法选择福建中医药大学附属龙岩人民医院神经外科自2013年1月至2017年6月收治的颅内动脉瘤夹闭同期行去骨瓣减压术(一期手术)患者144例,其中术后3个月行颅骨成形术(二期手术)患者88例(观察组),未行颅骨成形术患者56例(对照组)。一期手术前采用格拉斯哥昏迷量表(GCS)评估患者的昏迷程度,一期手术后3个月采用GCS和日常生活能力评分量表(ADL)评估患者的一般状况,一期手术后9、15个月采用GCS、格拉斯哥预后量表(GOS)和ADL评估患者的预后。比较2组患者的临床资料、预后及脑积水发生率。多因素Logistic回归分析筛选患者并发脑积水的危险因素。结果与对照组比较,观察组患者一期手术后9、15个月的GCS、GOS、ADL评分均较高,差异均有统计学意义(P<0.05);观察组患者脑积水发生率为31.82%,对照组为62.5%,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示颅骨成形术、Hunt-Hess分级、Fisher分级是患者并发脑积水的独立影响因素,其中颅骨成形术为患者并发脑积水的保护因素(OR=0.126),Hunt-Hess分级(OR=5.311)、Fisher分级(OR=5.073)为患者并发脑积水的危险因素。结论颅骨成形术可以降低颅内动脉瘤夹闭同期去骨瓣减压患者术后脑积水发生率,改善患者的预后。

Objective To investigate the effect of cranioplasty on prognosis of patients accepted intracranial aneurysm clipping combined with simultaneous decompressive craniectomy. Methods One hundred and forty-four patients accepted intracranial aneurysm clipping combined with simultaneous decompressive craniectomy (first-stage operation) in our hospital from January 2013 to June 2017 were chosen;there were 56 patients without cranioplasty in the control group and 88 patients with cranioplasty (second-stage operation) in the observation group. The degrees of coma before first-stage operation were assessed by Glasgow coma scale (GCS). The general state three months after first-stage operation was assessed by GCS and activity of daily living(ADL) scale. The prognoses of these patients 9 and 15 months after first-stage operation were assessed by Glasgow outcome scale (GOS) and ADL scale. The clinical data, prognoses and incidence of hydrocephalus of patients from the two groups were compared. Related factors associated with hydrocephalus were analyzed by multivariate Logistic regression analysis. Results GCS, GOS and ADL scale scores in the observation group 9 and 15 months after first-stage operation were all significantly higher than those in the control group (P<0.05);incidence of hydrocephalus in the observation group after first-stage operation (31.82%) was significantly lower than that in the control group (62.5%, P<0.05). Logistic regression model revealed that cranioplasty, Hunt-Hess grading and Fisher grading were independent related factors for incidence of hydrocephalus (P<0.05);cranioplasty was the protective factor of hydrocephalus (OR=0.126), and Hunt-Hess grading and Fisher grading were the risk factors of hydrocephalus (OR=5.311 and 5.073). Conclusion Cranioplasty can reduce the incidence of hydrocephalus and improve the prognosis of patients accepted intracranial aneurysm clipping combined with simultaneous decompressive craniectomy.