早期颅骨修补对颅脑损伤去骨瓣减压术后患者预后的影响

Effect of early cranioplasty for prognosis in craniocerebral injury patients after decompressive craniectomy

目的探讨早期颅骨修补对创伤性颅脑损伤去骨瓣减压术后患者日常生活能力和神经功能的影响。方法选取昆明市第一人民医院神经外科2016-01—2019-10收治的121例创伤性颅脑损伤去骨瓣减压术后患者为研究对象,根据颅骨修补的时机,将其分成早期组(术后≤3个月,50例)与晚期组(术后>3个月,71例)。比较2组患者术前、术后6个月功能独立性评定量表(FIM)评分、简明精神状态量表(MMSE)评分,同时比较术后并发症发生率、住院时间、术中失血量。结果早期组术后FIM评分、MMSE评分120.0(115.0,124.2)分和27.0(24.5,29.0)分较术前114.0(90.0,116.5)分和23.0(15.8,25.3)分均有所提高,同时晚期组术后FIM评分、MMSE评分117.0(110.0,120.0)分和26.0(18.0,27.0)分较术前115.0(105.0,119.0)分和24.0(16.0,26.0)分均有提高,差异具有统计学意义(均P<0.05)。术后早期组FIM评分、MMSE评分120.0(115.0,124.2)分和27.0(24.5,29.0)分较晚期组117.0(110.0,120.0)分和26.0(18.0,27.0)分提高更明显,差异具有统计学意义(均P<0.05);本组无死亡和感染病例,早期组和晚期组硬膜外血肿和积液发生率8%(4/50)和9.9%(7/71),癫痫发生率10%(5/50)和19.7%(14/71),脑积水的发病率4%(2/50),2.8%(2/71),术后住院时间8(7,9)d和8(7,9)d和术中失血量300(300,400)mL和300(250,350)mL差异均无统计学意义(均P>0.05)。结论早期颅骨修补(≤3个月)并未增加术后并发症的发生率和住院时间及术中失血量,且更有助于日常生活能力的改善和神经功能的恢复。

Objective To explore the effect of early cranioplasty for the activity of daily living and neurological function in craniocerebral injury patients after decompressive craniectomy.Methods We analyzed the data of 121 patients with craniocerebral injury patients after decompressive craniectomy in our hospital between January 2016 to October 2019.According to the opportunity of cranioplasty,they were divided into early group(≤3 months,n=50),and late group(>3 months,n=71).The two groups were compared by the functional independence rating scale(FIM)scores and the mini mental state examination(MMSE)scores before and 6 months after surgery,and the incidence of postoperative complications,length of hospital stay,and intraoperative blood loss were also compared.Results The FIM,MMSE scores after surgery(120.0(115.0,124.2)points and 27.0(24.5,29.0)points)were improved compared with the postoperation(114.0(90.0,116.5)points and 23.0(15.8,25.3)points)in the early group.Meanwhile,in the late group,the FIM,MMSE score of postoperation(117.0(110.0,120.0)points and 26.0(18.0,27.0)points)were improved compared with the preoperative score(115.0(105.0,119.0)points and 24.0(16.0,26.0)points).The difference was statistically significant(all P<0.05).The FIM,MMSE score(120.0(115.0,124.2)points and 27.0(24.5,29.0)points)in the early group were more significantly improved than the late group(117.0(110.0,120.0)points and 26.0(18.0,27.0)points)after surgery,with statistically significant differences(all P<0.05).There were no deaths or infections in this group.There was no statistical difference in postoperative complications(epidural hematoma and effusion,epilepsy,hydrocephalus),length of hospital stay,and intraoperative blood loss between the two group(both P>0.05).Conclusion Early cranioplasty(≤3 months)did not increase the incidence of postoperative complications,length of hospital stay or intraoperative blood loss,was more conducive to the activity of daily living improvement and neurological recovery.