颅脑损伤术后早期深低温保存自体颅骨修补颅骨缺损对患者神经功能及并发症的影响

目的分析颅脑损伤开颅去骨瓣减压术后接受深低温保存自体颅骨修补时机对患者神经功能恢复及并发症的影响。方法前瞻性对照研究2015年3月—2017年3月青岛大学附属医院因颅脑损伤接受开颅手术去骨瓣减压并-196℃深低温保存自体颅骨骨瓣患者216例,男性137例,女性79例;年龄18~60岁,平均44.4岁。依据开颅手术后颅骨修补时间间隔分为早期组(67例)和晚期组(149例)。早期组男性45例,女性22例;年龄18~59岁,平均43.3岁。晚期组男性92例,女性57例;年龄19~60岁,平均45.0岁。早期组为去骨瓣术后12周内接受深低温保存自体颅骨修补术;晚期组为去骨瓣术12周后接受深低温保存自体颅骨修补术。比较两组患者颅骨修补术后12个月颅骨修补感染、骨瓣吸收等相关并发症及神经功能恢复的差异。结果早期组和晚期组患者共发生感染8例,感染率为3.7%。手术区域及颅内感染发生分别为早期组2例、晚期组6例,两组比较差异无统计学意义(P=0.525)。晚期组术后皮下积液发生例数多于早期组,但差异无统计意义(17例vs.3例,P=0.008);早期组骨瓣不愈合/吸收发生例数少于晚期组(7例vs.41例,P=0.003)。术后12个月早期组Barthel指数(BI)高于晚期组(79.85±7.43)分vs.(70.18±8.16)分,t=2.623,P=0.004。术后12个月早期组GOS评分高于晚期组(3.98±0.94)分vs.(3.22±0.87)分,t=1.834,P=0.041。结论早期深低温保存自体颅骨修补术可以改善颅脑损伤开颅去骨瓣术后患者神经功能恢复,降低颅骨修补并发症的发生率。

Effect of early deep cryopreservation of autologous skull repair for cranial defect on neurological function and complications in craniocerebral injury patients

Objective To analyze the effect of early deep cryopreservation of autologous skull repair for cranial defect on neurological function and complications in craniocerebral injury patients.Methods From Mar.2015 to Mar.2017,216 patients who underwent craniotomy for trauma brain injury at the Affiliated Hospital of Qingdao University and preservation of autologous cranial bone flaps at-196°C were randomly divided into early group(67 cases)and late group(149 cases)according to the time interval of skull repair after craniotomy.In the early group,there were 45 males and 22 females;their age ranged from 18 to 59 years,with an average of 43.3 years.In the advanced group,there were 92 males and 57 females;their age ranged from 19 to 60 years,with an average of 45.0 years.The early group received deep cryopreserved autologous skull repair within 12 weeks after craniotomy;the late group received deep cryopreserved autologous skull repair within 12 weeks after craniotomy.The differences of complications such as cranial repair infections,bone flap resorption and nerve function recovery were compared between the two groups.Results A total of 8 patients were infected in the early and late stages(2 cases in the early group and 6 cases in the late group),with an infection rate of 3.7%.Postoperative subcutaneous effusion in the late group was higher than that in the early group,but the difference was not statistically significant(17 cases vs.3 cases,P=0.08).Bone flap non-healing/absorption rate of the observation group was lower than that of the control group(7 cases vs.41 cases,P=0.003).The Barthel index score of the observation group at 12 months after surgery was higher than that of the control group(79.85±7.43 vs.70.18±8.16,t=2.62,P=0.004).GOS of the observation group was higher than that of the control group(3.98±0.94 vs.3.22±0.87,t=1.83,P=0.041).Conclusion Early deep cryopreservation of autologous skull repair for cranial defect after craniotomy can improve the prognosis of neurological function and reduce the incidence of complications in patients with brain injury.