早期颅骨修补治疗去骨瓣减压术后减压窗明显膨出的临床研究

目的探讨去骨瓣减压术后减压窗明显膨出患者的早期颅骨修补的临床疗效。方法选取我院2008年2月～2011年2月收治的去骨瓣减压术后减压窗明显膨出患者52例,其中采用术后常规颅骨修补（≥6个月）治疗患者26例为对照组,采用早期颅骨修补（〈6个月）治疗患者26例为观察组,比较两组患者的临床疗效及预后情况（GOS评分、KPS评分、认知功能评分）。结果颅脑创伤后15个月时观察组GOS评分、KPS评分明显高于对照组,颅脑创伤后15个月的GOS评分、KPS评分均明显高于去骨瓣减压术后2周,观察组认知功能评分明显高于对照组,差异均有统计学意义（均P〈0.05）。去骨瓣减压术后2周时观察组GOS评分、KPS评分高于对照组,观察组住院康复人数、针灸人数均多于对照组,观察组高压氧治疗超过20 d人数少于对照组,观察组并发症发生率低于对照组,差异均无统计学意义（均P〉0.05）。结论早期颅骨修补可以明显改善去骨瓣减压术后减压窗明显膨出患者的临床症状,恢复颅腔的生理完整性,提高患者的认知功能,严格掌握患者的手术适应证可以明显改善患者的预后,是一种安全有效的治疗方法,值得临床推广使用。

Clinical research on early cranioplasty for patients with decompression window significantly encephalocele after decompressive craniectomy

Objective To investigate clinical efficacy of early cranioplasty for patients with decompression window significantly encephalocele after decompressive craniectomy.Methods 52 patients with decompression window significantly encephalocele after decompressive craniectomy were selected in the hospital from February 2008 to February 2011.26 patients used routine postoperative skull repair（≥6 months） in the treatment as control group.26 patients used early cranioplasty（ 6 months） in the treatment as observation group.Clinical efficacy and prognosis（GOS score,KPS score,Cognitive function score） were compared between two groups.Results When 15 months after craniocerebral trauma,GOS score,KPS score in the observation group were significantly higher than those in the control group.GOS score,KPS score of patients 15 months after craniocerebral trauma were significantly higher than those of patients 2 weeks after decompressive craniectomy.Cognitive function score in the observation group was significantly higher than that in the control group.There were statistically significant diggerences（all P 0.05）.When 2 weeks after decompressive craniectomy,GOS score,KPS score in the observation group were higher than those in the control group.The numbers of inpatient rehabilitation,acupuncture in the observation group were greater than those in the control group.The number of patients treated with hyperbaric oxygen in excess of 20 d in the observation group was less than that in the control group.Complication rate in the observation group was lower than that in the control group.There were no significant difference between them（all P 0.05）.Conclusion Early cranioplasty can improve obviously clinical symptoms of patients with decompression window significantly encephalocele after decompressive craniectomy,which can also recover the cranial cavity physiological integrity and improve the cognitive function of patients.Strict control of indications can obviously improve the prognosis of patients.That is a safe and effective method of treatment,which is worthy of clinical use.