颅脑损伤术后颅骨修复时机的选择及其对病人神经功能的影响

Effect of cranioplasty timing on neurological rehabilitation of patients with traumatic brain injury after decompressive craniectomy

目的探讨颅脑损伤术后颅骨成形术时机对病人神经功能的影响。方法回顾性分析2018年1月至2019年6月去骨瓣减压术治疗的112例颅脑损伤的临床资料。去骨瓣减压术后1~3个月颅骨成形术46例(早期组),去骨瓣减压术后3个月以后颅骨成形术66例(常规组)。术前及术后2周,颅脑CT灌注扫描评估脑灌注情况,包括相对局部脑血流量(rCBF)、相对脑血容量(rCBV)、相对平均通过时间(rMTT)、相对达峰时间(rTTP);采用美国国立卫生研究院卒中量表(NIHSS)评分评价神经功能,采用简明精神状态量表(MMSE)评分评价认知功能。术后6个月,采用GOS评分评价临床预后,4~5分为预后良好。结果术后2周,两组rCBF、rCBV、MMSE评分均明显升高(P<0.05),rMTT、rTTP、NIHSS评分均明显降低(P<0.05),而且早期组明显优于常规组(P<0.05)。术后6个月,早期组预后良好率(86.96%,40/46)明显高于常规组(74.24%,49/66;P<0.05)。早期组术后并发症总发生率(10.87%,5/46)与常规组(16.67%,11/66)无统计学差异(P>0.05)。结论颅脑损伤术后早期颅骨成形术是安全可行的,不增加并发症发生风险,有利于改善脑血流灌注状态及神经功能,改善临床预后。

Objective To investigate the effect of cranioplasty timing on the neurological rehabilitation of patients with traumatic brain injury(TBI)after decompressive craniectomy(DC).Methods The clinical dat of 112 patients with TBI who underwent DC from January 2018 to June 2019 were analyzed respectively.Of these 110 patients,46 patients received cranioplasty 1~3 months after the DC(early group)and 66 patients received cranioplasty 3~6 months after the DC(conventional group).Before and 2 weeks after the cranioplasty,the relative cerebral blood flow(rCBF),cerebral blood volume(rCBV),average transit time(rMTT),and peak time(rTTP)were detected by brain perfusion CT scan;the neurological function was evaluated by the National Institutes of Health Stroke Scale(NIHSS)score;the cognitive function was assessed by the mini-mental state scale(MMSE)score.The clinical prognosis was evaluated by the GOS score 6 months after the cranioplasty.Results Two weeks after the cranioplasty,the rCBF,rCBV and MMSE score signifcantly increased,the rMTT,rTTP and NIHSS score significantly decreased in both the groups(P<0.05),and the outcomes of early group were significantly better than those of conventional group(P<0.05).The good prognosis rate(GOS score of 4~5)of early group(86.96%,40/46)was significantly higher than that(74.24%,49/66)of convertional group(P<0.05).There was no significant difference in the postoperative complication rate between the two groups(P>0.05).Conclusions Early cranioplasty is safe and feasible for the patients with TBI after DC,which does not increase the risk of complications,and is beneficial to improve the cerebral blood perfusion,neurological function,and clinical prognoses.