标准大骨瓣减压术后不同时期行颅骨修补术的疗效及并发症观察

目的探讨基层医院中重型颅脑损伤（sTBI）标准去大骨瓣减压术后患者不同时期行颅骨修补的疗效及并发症的影响。 方法选取青岛市西海岸新区人民医院神经外科自2012年1月至2017年6月收治的94例标准去大骨瓣减压术后行颅骨修补患者的临床资料进行分析，按去骨瓣术后修补时间的不同，将其分为修补早期（去骨瓣术后1~3个月）组53例和晚期（去骨瓣术后3~6个月）组41例；比较2组患者颅骨修补术前及术后1年并发症发生率、神经及认知功能恢复和生存质量情况。 结果早期组1年后并发症发生率较晚期组明显降低，差异具有统计学意义（χ²=5.502，P<0.05）；早期组和晚期组在颅骨修补术前GOS评分和Karnofsky功能状态（KPS）评分相比，差异无统计学意义（P>0.05），在颅骨修补术后1年，早期组患者的GOS、KPS评分提高明显优于晚期组，差异有统计学意义（P<0.05）；早期组和晚期组颅骨修补术前及术后1年的中国脑卒中患者临床神经功能缺损程度评分量表（CSS）、简易智能精神状态量表（MMSE）评分比较，2组患者术后评分均高于术前，并且术后1年早期组CSS和MMSE评分与晚期组相比，差异均有统计学意义（P<0.05）。 结论标准去大骨瓣减压术后的sTBI患者，早期（1~3个月）颅骨修补明显减少远期并发症发生，能够显著促进神经功能和认知功能的恢复，提高患者远期生活质量。

Curative effect and complication of cranioplasty at different periods after standard bone flap decompression

ObjectiveTo explore the clinical effect of different terms cranioplasty following large decompressive craniectomy in the treatment of severe traumatic brain injury (sTBI). MethodsRetrospective analysis of clinical data of 94 patients with decompressive craniectomy, admitted to our hospitals from January 2012 to June 2017, was performed; these patients were divided into early treatment group (given treatment within 1-3 months, n=53), and late treatment group (given treatment 3-6 months, n=41); the differences of complications and survival quality between the two groups were respectively observed. ResultsAfter 1 year of cranioplasty, the complications of early treatment group had a higher rate than the late treatment group (χ²=5.502, P<0.05). There is no significant difference of GOS and KPS grade between the two groups before cranioplasty, but 1 year later after cranioplasty, early treatment group had a higher grade of GOS and KPS than the late treatment group (P<0.05). Furthermore, compared of CSS and MMSE between the two different treatment groups, there was significant difference between the postoperative score and preperative (P<0.05). Meantime, the CSS and MMSE of early treatment group got significantly different scores than the late treatment group (P<0.05). ConclusionEarly cranioplasty following decompressive craniectomy helps improving the prognosis, reducing complications, promoting recovery and the quality of life.