联合手术对脑外伤患者的临床效果及术后硬膜下积液的危险因素分析

Clinical effect of combined therapy for patients with traumatic brain injury and analysis in risk factors of postoperative subdural effusion

目的观察脑外伤去骨瓣减压术联合早期颅骨成形术的临床效果,并分析术后硬膜下积液的危险因素。方法选取脑外伤行去骨瓣减压术患者120例为研究对象,根据术后行颅骨成形术的时间分为对照组(n=80)与研究组(n=40)。比较2组患者颅骨成形术后神经功能、运动功能、日常功能及术后并发症发生情况,并分析术后硬膜下积液的危险因素。结果术后2个月,研究组美国国立卫生研究院卒中量表(NIHSS)评分低于术前、术后15 d及对照组,Fugl-Meyer评分、生活质量(Barthel)评分高于术前、术后15 d与对照组,差异有统计学意义(P<0.05);研究组硬膜下积液、颅脑缺损综合征发生率低于对照组,差异有统计学意义(P<0.05)。中线移位、脑内血肿、蛛网膜撕裂、皮层切开、骨瓣边缘距中线距离、骨窗面积均为术后硬膜下积液的影响因素(P<0.05)。结论脑外伤去骨瓣减压术联合早期颅骨成形术能有效改善患者神经功能、运动功能与日常生活功能,降低术后并发症发生率。中线移位、脑内血肿、蛛网膜撕裂、皮层切开、骨瓣边缘距中线距离、骨窗面积均为术后硬膜下积液的影响因素。

Objective To observe the clinical effect of decompression of bone flap combined with early cranioplasty for traumatic brain injury and to analyze the risk factors of postoperative subdural effusion.Methods A total of 120 patients with brain trauma underwent decompression of bone flap were selected as study objects.According to the time of cranioplasty after operation,they were divided into control group(n=80)and study group(n=40).Nerve function,movement function,daily function and postoperative complications after cranioplasty were compared and the risk factors of postoperative subdural effusion were analyzed.Results Two months after surgery,the National Institutes of Health Stroke Scale(NIHSS)score in the study group was lower than that before surgery,15 d after surgery and the control group,while Fugl-Meyer scores and life quality(Barthel)scores were higher than those before surgery,15 d after surgery and the control group(P<0.05).The incidence rates of subdural effusion and craniocerebraldefect syndrome in the study group were lower than those in the control group(P<0.05).Midline displacement,intracerebral hematoma,arachnoid tear,cortical incision,the distance between the edge of bone flap and the midline,and the area of bone window were all the influencing factors of postoperative subdural effusion(P<0.05).Conclusion Decompression of bone flap combined with early skull plasty for patients with traumatic brain injury can effectively improve neural function,motor function and daily life function,and reduce incidence of postoperative complications.Midline shift,the brain hematoma,arachnoid tear,cortex incision and the distance between the edge of bone flap and the midline,bone window area are related influencing factors of postoperative subdural effusion.