标准大骨瓣开颅减压术后早期颅骨修补

目的探讨标准大骨瓣开颅减压术(SLTC)后早期颅骨修补对患者预后的影响及其可行性。方法72例实施SLTC的颅脑损伤患者,伤后3个月内实施颅骨修补者42例为观察组,按常规伤后3个月后颅骨修补者30例为对照组,使用改良功能生活指数量表(RFLI)对2组患者伤后1 a的生活质量进行评估。结果伤后4周及1 a,观察组生活质量评分分别为(54.4±17.6)分和(83.3±13.1)分,对照组生活质量评分分别为(53.9±18.4)分和(71.4±16.8)分,伤后4周2组生活质量评分无差别(P>0.05),伤后1 a观察组生活质量评分明显高于对照组(P<0.01)。伤后1 a内,观察组颅骨缺损综合征发病率明显低于对照组(P<0.05),颅骨修补术后并发症发生率2组比较无统计学意义(P>0.05)。结论SLTC后早期修补可及早预防、终止或逆转颅骨缺损而造成的继发性脑损害,解除颅骨缺损带来的精神负担,提高患者生活质量。

Efficacy of early cranioplasty in patients with large standard bone flap craniotomy

Objective To explore the feasibility and clinical results of early cranioplasty in patients with large standard bone flap craniotomy. Methods Large standard bone flap craniotomy was performed in 72 cases with traumatic brain injury. 42 cases were selected as observation group who were performed with early cranioplasty within 3 months, 30 cases with operation beyond 3 months were chose as control group. Revising functional living index （ RFLI ） form was used to evaluate the quality of life of all cases in one year after injury. Results After four weeks and one year, scores of quality of life were （54.4 ± 17.6） and （ 83.3 ±13.1 ） in observation group ,and they were （53.9 ±18.4） and （71.4 ±16.8） in control group. There was no difference in the quality of life between two groups after four weeks （ P 〉 0.05 ）, but in observation group it was higher than that in control group after one year（P 〈 0.05 ）. The incidence of skull defects syndrome was lower in observation group than in control group （ P 〈 0.05 ）. There was no difference in incidence rate of complications following cranioplasty between two groups （ P 〉 0. 05 ）. Conclusion Early cranioplasty can prevent or reverse secondary brain injury from large skull defects of craniotomy, and ease off the mental pressure and improve the quality of life.