早期颅骨修补对行去骨瓣减压术的脑损伤及脑出血患者预后的影响研究

Effect of early cranioplasty on the prognosis of patients with brain injury and intracerebral hemorrhage hundergoing decompressive craniectomy

目的研究早期颅骨修补对行去骨瓣减压术的脑损伤及脑出血患者的术前术后神经功能缺损评分及并发症的影响.方法选取深圳市宝安区沙井人民医院神经外科自2016年1月至2018年5月收治的76例行去骨瓣减压术的脑损伤及脑出血患者作为研究对象,采用随机数字表法将入组患者分为早期组(35例)和对照组(41例),早期组在去骨瓣减压术后4~6周内实施颅骨修补,对照组在术后3~6个月后实施修颅骨修补,对比2组患者术前术后的美国国立卫生研究院卒中量表(NIHSS)评分、术后并发症发生情况以及日常生活能力评分(ADL)和肢体运动功能评分(Fugl-Meyer).结果治疗前2组患者的NIHSS评分、ADL评分及Fugl-Meyer评分比较,差异均无统计学意义(P>0.05).治疗后2组患者的NIHSS评分均显著下降(P<0.05),且早期组的NIHSS评分显著低于对照组;早期组的ADL评分和Fugl-Meyer评分显著高于对照组(P<0.05);早期组的并发症发生率显著低于对照组(P<0.05).结论颅脑损伤患者实施去骨瓣减压术后,早期实施颅骨修补能够显著改善患者的神经功能缺损状况,并有助于降低术后并发症的发生,对于患者的临床治疗和预后恢复具有积极的影响.

Objective To study the effect of early cranioplasty on neurological deficit scores and complications in patients with brain injury and cerebral hemorrhage before and after decompressive craniectomy. Methods Seventy-six patients with brain injury and cerebral hemorrhage who underwent decompressive craniectomy from January 2016 to May 2018 in Shajing People’s Hospital of Baoan District of Shenzhen City were selected as the research subjects. The patients were divided into early group and control group by random number table. The early group was implemented cranioplasty within 4-6 weeks after decompressive craniectomy. Cranioplasty was performed in the control group 3-6 months after operation. The scores of preoperative and postoperative National Institutes of Health stroke scale(NIHSS),postoperative complications, ability of daily living score(ADL) and limb motor function score(Fugl-Meyer)were compared between the two groups. Results There was no significant statistical difference in NIHSS score, ADL score and Fugl-Meyer score between the two groups before treatment(P >0.05). After treatment, the NIHSS scores of both groups decreased significantly(P<0.05), and the NIHSS scores of the early group were significantly lower than those of the control group;the ADL scores and Fugl-Meyer scores of the early group were significantly higher than those of the control group(P<0.05);and the incidence of complications of the early group was significantly lower than that of the control group(P <0.05).Conclusion Early cranioplasty after decompressive craniectomy of patients with craniocerebral trauma can significantly improve the neurological deficits and reduce the incidence of complications. It has a positive impact on the clinical treatment and prognosis of patients with craniocerebral trauma.