不同时期颅骨修补治疗颅骨缺损的疗效观察

目的 分析不同时期行颅骨修补后去骨瓣减压患者的术后并发症和预后,探讨颅脑外伤去骨瓣减压术后颅骨修补的最佳时机.方法 回顾性分析2012年11月至2015年11月在我院行颅骨修补术83例患者的临床资料,根据去骨瓣减压术后至颅骨修补的时间将其分为早期组(≤3个月)31例和晚期组(＞3个月)52例.比较两组患者术后并发症的发生率,采用格拉斯哥预后分级(GOS)评分和卡氏功能状态(KPS)评分对患者的预后进行临床评价.结果 早期组患者术后脑积水的发生率(16.13％,5/31)高于晚期组(1.92％,1/52),差异有统计学意义(P＜0.05);两组间其他术后并发症的发生率差异无统计学意义.早期组患者术后GOS患者和KPS评分高于晚期组,差异有统计学意义(GOS评分:4.16±0.86 vs 3.63±0.72,P＜0.05;KPS评分:80.32±16.22 vs 70.19±16.27,P＜0.05).结论 颅脑外伤去骨瓣减压术后早期颅骨修补较晚期修补可以改善患者的神经功能和预后,但可能会增加脑积水的发生风险.

Curative effect of cranioplasty for skull defect at different stages after decompressive craniectomy

Objective To analyze the postoperative complications and prognosis of the patients undergoing cranioplasty at different stages after decompressive craniectomy,and to explore the optimal timing of cranioplasty after decompressive craniectomy for skull defect.Methods We retrospectively analyzed the clinical data of 83 patients who underwent cranioplasty from Nov.2012 to Nov.2015.According to the different timing of cranioplasty after decompressive craniectomy,the patients were divided into the early-stage group (≤3 months,n=31) and the late-stage group (＞3 months,n=52).We recorded and compared the incidence of postoperative complications in the two groups.The Glasgow outcome score (GOS) and Karnofsky performance status (KPS) score were used to evaluate the prognosis of the patients in the two groups.Results The incidence of hydrocephalus in the early-stage group (16.13％,5/31) was significantly higher than that in the late-stage group (1.92％,1/52;P＜ 0.05),while the incidence of other postoperative complications was not significantly different.And the GOS score and KPS score of the early-stage group were significantly higher than those of the late-stage group (GOS score:4.16±0.86 vs 3.63±0.72,P＜0.05;KPS score..80.32±16.22 vs 70.19±16.27,P＜0.05).Conclusion Early cranioplasty after decompressive craniectomy can improve the neurological function and prognosis of the patients with traumatic brain injury,but it may increase the incidence of hydrocephalus.