早期颅骨修补对成人颅脑外伤患者预后的影响

Relationship between early cranioplasty and outcomes of traumatic brain injury in adult patients

目的探讨去骨瓣减压术后早期颅骨修补对成人颅脑外伤患者预后的影响。方法回顾性分析厦门大学附属中山医院神经外科2015年1月至2017年6月收治的72例成人颅脑外伤术后患者的临床资料。根据其颅骨修补时机,分为早期组(术后≤3个月,30例)和常规组(术后>3个月,42例)。比较两组患者术后6个月的格拉斯哥预后评分(GOS)、Karnofsky功能状态评分(KPS)、简明精神状态量表(MMSE)评分以及术后并发症的发生情况。结果相比常规组,早期组在术前、术后GOS的变化值[中位数(上、下四分位数)分别为1.0(1.0,1.0)和1.0(0,1.0)]、术后KPS[分别为(70.3±23.3)分和(58.8±17.3)分)]以及术后MMSE评分[分别为(21.0±7.7)分和(17.5±6.2)分)]均有提高,差异具有统计学意义(均P<0.05);而早期组和常规组术后感染[分别为16.7%(5/30)和7.1%(3/42)]和癫痫的发生率[分别为10.0%(3/30)和9.5%(4/42)]的差异均无统计学意义(均P>0.05)。结论与术后>3个月修补相比,早期颅骨修补(术后≤3个月)并不增加术后并发症的发生率,且对患者的预后有更显著的改善作用。

Objective To investigate the effects of early cranioplasty post decompressive craniectomy on the outcomes of traumatic brain injury in adult patients.Methods A retrospective analysis was conducted on the clinical data of 72 adult postoperative patients with traumatic brain injury who were admitted to Department of Neurosurgery,Zhongshan Hospital,Xiamen University from January 2015 to June 2017.According to the timing of cranioplasty,the patients were divided into early group(≤3 months after operation,30 cases)and conventional group(>3 months after operation,42 cases).The differences in the Glasgow outcome scale(GOS)score,Karnofsky performance scale(KPS)score and mini-mental state examination(MMSE)score between the two groups were compared at 6 months postoperatively,and the rates of postoperative complications were also compared.Results Compared with the conventional group,the GOS change values[the median(lower interquartile,upper interquartile):1.0(1.0,1.0)points vs.1.0(0,1.0)points],postoperative KPS(70.3±23.3 points vs.58.8±17.3 points)and MMSE scores(21.0±7.7 points vs.17.5±6.2 points)were significantly improved in the early group,and the differences were statistically significant(all P<0.05).There was no statistical difference in the incidence of infection or epilepsy between the two groups(both P>0.05).Conclusion Compared with cranioplasty at 3 months post operation,early cranioplasty does not seem to increase the incidence of postoperative complications and has more significant improvement in the outcomes of patients.