创伤性脑损伤去骨瓣术后聚醚醚酮颅骨修补的疗效

Effect of polyetheretherketone cranioplasty following craniectomy for traumatic brain injury

目的探讨创伤性脑损伤(TBI)患者去骨瓣术后行聚醚醚酮(PEEK)颅骨修补的效果。方法采用回顾性病例系列研究分析2017年2月至2021年4月上海交通大学医学院附属仁济医院收治的85例TBI去骨瓣术后患者的临床资料, 其中男57例, 女28例;年龄7~70岁[(40.8±15.5)岁]。格拉斯哥昏迷评分(GCS)为6~15分[15(13, 15)分]。患者均择期行PEEK颅骨修补术。术前、术后3个月及术后6个月采用改良格拉斯哥预后评分(GOSE)评估预后情况。排除术前GOSE为8分的33例患者后, 针对修补前GOSE<8分的52例患者进行GOSE改善程度分析。术后6个月采用电话随访评估患者对PEEK颅骨修补的满意度。观察住院期间及术后6个月内并发症发生情况。结果患者均获随访6~7个月[6(6, 7)个月]。患者术前GOSE为6(5, 8)分, 术后3个月为6(5, 8)分, 术后6个月为7(5, 8)分。术后3个月GOSE与术前差异无统计学意义(P>0.05), 而术后6个月较术前明显提高(P<0.05)。在术后3个月时, 10例GOSE较术前轻度改善, 42例GOSE未改善;而术后6个月时, 4例GOSE较术前明显改善, 17例GOSE轻度改善, 31例未改善(P<0.05)。患者满意度:非常满意43例, 比较满意33例, 一般7例, 不满意2例。住院期间及术后6个月内, 25例患者出现术后并发症, 并发症发生率为29%。其中伤口感染1例, 新发癫痫1例, 硬膜外出血8例, 修补部位皮下积液13例, 严重感染、皮下积液和材料外露1例, 严重感染、新发癫痫和皮下积液1例。2例因并发多种并发症取出材料。其余患者并发症经治疗后明显好转, 未影响日常生活。结论 TBI去骨瓣术后行PEEK颅骨修补, 患者预后得到改善, 满意度高, 术后感染和材料外露发生率低。

Objective To investigate the effect of cranioplasty with polyetheretherketone(PEEK)after craniectomy in patients with traumatic brain injury(TBI).Methods A retrospective case series study was used to analyze the clinical data of 85 TBI patients undergone craniectomy admitted to Renji Hospital,Shanghai Jiaotong University School of Medicine from February 2017 to April 2021,including 57 males and 28 females,aged 7-70 years[(40.8±15.5)years].Patients′Glasgow Coma Scale(GCS)was 6-15 points[15(13,15)points].All patients underwent PEEK cranioplasty as scheduled.The extended Glasgow Outcome Scale(GOSE)was used to evaluate the neurological function before,at 3 and 6 months after operation.After excluding 33 patients with preoperative GOSE score of 8 points,52 patients with preoperative GOSE score less than 8 points were analyzed on the degree of GOSE improvement.Patients′satisfaction with PEEK repair was evaluated through telephone interviews at 6 months postoperatively.The incidence of complications were observed during hospitalization and within 6 months postoperatively.Results All patients were followed up for 6-7 months[6(6,7)months].The GOSE was 6(5,8)points before operation,6(5,8)points at 3 months after operation,and 7(5,8)points at 6 months after operation.There was no significant difference in GOSE at 3 months after operation and before operation(P>0.05),but it was significantly increased at 6 months after operation when compared to the preoperative level(P<0.05).With regards to GOSE,there were 10 patients with mild amelioration but 42 with no amelioration at 3 months after operation,while 4 patients with significant amelioration and 31 with no amelioration were observed at 6 months after operation(P<0.05).For PEEK repair,Patients′satisfaction was very high in 43 patients,high in 33,general in 7 and poor in 2.A total of 25 patients had postoperative complications during hospitalization and within 6 months postoperatively,with the incidence of complications of 29%.Specifically,there was 1 patient with wound infection,1 new epilepsy,8 epidural hemorrhage,13 subcutaneous effusion,1 subcutaneous effusion,severe infection and material exposure,and 1 severe infection,new-onset epilepsy and subcutaneous effusion.Repair materials were removed in 2 patients due to multiple complications;other patients obtained alleviation via treatment,without affect on their daily life.Conclusion PEEK cranioplasty following craniectomy for TBI patients can improve prognosis,attain high satisfaction and has low incidences of postoperative infection and exposure of repair materials.