重型脑外伤后早期颅骨成形改善神经功能及预后

目的 分析重型颅脑外伤去骨瓣减压术后早期颅骨成形术对患者短期、长期神经功能康复及预后的影响.方法 回顾性分析因重型颅脑外伤而进行去骨瓣减压术遗留大面积颅骨缺损的患者27例,在去骨瓣减压后早期进行颅骨成形术(5～8 w),另随机选取常规时间进行颅骨成型术病例27例(术后3～6个月),均采用计算机三维塑性钛网为修补材料.早期结果于术后12 d、1个月进行评估,包括Barthel指数、Fugl-meyer评分、神经功能缺损评分,并评估并发症的发生.术后18个月采用生活质量主观评分及GOS评分评估长期预后.结果 颅骨成形术后12 d各项指标差异无统计学意义,1个月后早期组评价指标优于常规组(P<0.05),尤以Barthel评分显著(P=0.009).早期组患者颅骨成形后1个月、18个月的生活质量评分亦优于常规组,颅骨缺损综合征及硬膜下积液等并发症减少,组间差异有统计学意义,其余并发症无差别;早期组长期预后评分高于常规组,各项并发症术后18个月无明显变化.结论 选择合适的患者和修补材料,大面积去骨瓣减压术后早期进行颅骨成形术是安全的,可减少术后并发症的发生,有助于患者神经功能的恢复,改善远期预后.

Cranioplasty after severe brain injury at early stage improves the neurological functions and prognosis

Objective To analyze the effect of cranioplasty at early stage after severe brain injury on short-term and long-term neurological rehabilitation and prognosis.Methods A retrospective study was carried out in 27 cases with large skull defects after decompressive craniectomy because of severe brain injury.Cranioplasty was performed at early stage after decompressive craniectomy（5-8 w）.Twenty-seven cases performed the cranioplasty in conventional time（3-6 months postoperation） were selected randomly as control group.Three-dimensional titanium plate was used for the repair.Barthel index,Fugl-Meyer score,neurological deficit scores were used in the early outcome evaluation 12 d and 1 month postoperation,and the incidence of complications was assessed.Subjective score for quality of life and GOS were used for the evaluation of long-term prognosis at 18 months postoperation.Results There was no significant difference in all parameters at 12 d after cranioplasty.The parameters of early repair group were better than that of conventional group 1 month after cranioplasty（P〈0.05）,with the Barthel score the most significant（P=0.009）.The quality of life score was higher in early group than control group 1 month and 18 months postoperation.Syndrome of the trephined and subdural effusion were significantly decreased,with significant difference in two groups.There was no difference in the incidence of other complications in two groups.The scores for long-term prognosis in early group was higher than that in control group.Conclusion Cranioplasty at early stage following decompressive craniectomy is safe and helpful for the decrease of complications,recovery of neurological functions and improvement of long-term prognosis.