早期颅骨成形术对重型颅脑损伤去骨瓣减压术后病人预后 的影响

目的 探讨早期颅骨成形术对重型颅脑损伤去骨瓣减压术病人预后的影响。方法 回顾性分析2017年7月~2019年6月收治的100例去骨瓣减压术治疗的重型脑损伤的临床资料。术后3~6个月行三维钛网颅骨成形术43例（对照组），术后5~8周行三维钛网颅骨成形术57例（观察组）。术前、术后48 h进行CT灌注成像检查检测缺损侧顶叶皮质和缺损处皮质血流量。术后12个月采用GOS评分评估预后，4~5分为预后良好，1~3分为预后不良。术前、术后12个月采用美国卫生研究院卒中量表（NIHSS）评分评估神经功能，采用简易智力状况检查量表（MMSE）评估认知功能，采用Barthel指数评估日常生活能力。结果 术后48 h，两组顶叶皮质和缺损处皮质血流量均明显改善（P<0.05），而且观察组明显优于对照组（P<0.05）。术后12个月，观察组预后良好率（85.96%，49/57）明显高于对照组（65.12%，28/43；P<0.05），观察组NIHSS评分明显低于对照组（P<0.05），MMSE评分和Barthel指数明显高于对照组（P<0.05）。结论 重型颅脑损伤去骨瓣减压术后病人，早期颅骨成形术有利于改善脑血流动力，促进神经功能恢复，改善病人预后。

Effect of early cranioplasty on prognoses of patients with severe traumatic brain injury after decompressive craniectomy

Objective To explore the effect of early cranioplasty on the prognoses of patients with severe traumatic brain injury (TBI) after decompressive craniectomy (DC). Methods A retrospective analysis was performed on the clinical data of 100 patients with TBI underwent DC from July 2017 to June 2019. Forty-three patients reveived cranioplasty 3 to 6 months after the DC (control group), and 57 patients received cranioplasty 5 to 8 weeks after the DC (obseravtion group). CT perfusion imaging was performed to measure the blood flow of the parietal cortex on the defect side and the cortex of the defect before and 48 hours after the cranioplasty. The GOS score was used to evaluate the prognosis 12 months after the cranioplasty, with good prognosis of 4~5 points. Before and 12 months after the cranioplasty, the National Institutes of Health stroke scale (NIHSS) scores were used to assess neurological function, the Mini Mental State Examination Scale (MMSE) was used to assess the cognitive function, and the Barthel index was used to assess the ability of daily living. Results Forty-eight hours after the cranioplasty, the blood flow of the parietal cortex and the defect in the observation group was significantly better than the control group (P<0.05). Twelve months after the cranioplasty, the good prognosis rate of the observation group (85.96%, 49/57) was significantly higher than that (65.12%, 28/43) of the control group (P<0.05), the NIHSS score of the observation group was significantly lower than that of the control group (P<0.05), and the MMSE score and Barthel index of the observation group were significantly higher than those of the control group (P<0.05). Conclusion For severe TBI patients after DC, early cranioplasty is beneficial to improve cerebral blood flow, promote nerve function recovery, and improve patients’ prognoses.