摘要
目的探讨颅脑损伤患者去骨瓣减压术后在不同时期行颅骨修补对疗效和并发症的影响。方法回顾性分析成都医学院第一附属医院2014年1月至2018年1月收治的96例颅脑损伤去骨瓣减压术后的患者,根据颅骨修补时间不同将患者分为早期组和常规组。早期组50例,于去骨瓣减压术后1.5~3.0个月行颅骨修补术;常规组46例,于去骨瓣减压术后3.1~6.0个月行颅骨修补术。观察两组颅骨修补术后并发症情况,记录患者颅骨修补术前及术后3、6、12个月的格拉斯哥预后评分(GOS)和Karnofsky功能状态评分(KPS)。结果两组切口延迟愈合、皮下积液、切口感染、脑积水、颅内出血及总并发症发生率比较差异无统计学意义(P>0.05);早期组癫痫发生率明显低于常规组[0比8.70%(4/46)],差异有统计学意义(P<0.05)。两组术前GOS和KPS比较差异无统计学意义(P>0.05);早期组术后3、6和12个月GOS和KPS明显高于常规组[GOS:(3.58±0.64)分比(3.20±0.74)分、(3.90±0.58)分比(3.61±0.61)分和(4.22±0.55)分比(3.98±0.45)分,KPS:(56.20±8.55)分比(52.17±7.86)分、(68.40±9.12)分比(63.91±10.22)分和(75.20±9.31)分比(70.43±10.53)分],差异有统计学意义(P<0.01或<0.05)。结论颅脑损伤去骨瓣减压术后早期行颅骨修补能降低术后癫痫的发生率,并且更有利于患者术后神经功能康复,改善患者预后。
Objective To investigate the clinical effects and complications of different period cranioplasty after decompressive craniectomy in patients with craniocerebral injury.Methods The clinical data of 96 craniocerebral injury patients who had underwent decompressive craniectomy in the First Affiliated Hospital of Chengdu Medical College from January 2014 to January 2018 were retrospectively analyzed.According to the different time of cranioplasty,the patients were divided into early group and routine group.In the early group,50 patients received cranioplasty between 1.5 to 3.0 months after decompressive craniectomy;while in the conventional group,46 patients received cranioplasty between 3.1 to 6.0 months after decompressive craniectomy.The complications after cranioplasty were observed in 2 groups,and Glasgow outcome score(GOS)and Karnofsky performance score(KPS)before cranioplasty and 3,6 and 12 months after cranioplasty were recorded.Results There were no statistical difference in delayed wound healing,subcutaneous hydrops,incision infection,hydrocephalus,intracranial hemorrhage and total incidence of complications between 2 groups(P>0.05).However,the incidence of postoperative epilepsy in early group was significantly lower than that in routine group:0 vs.8.70%(4/46),and there was statistical difference(P<0.05).There were no statistical differences in GOS and KPS before cranioplasty between 2 groups(P>0.05);the GOS and KPS 3,6 and 12 months after cranioplasty in early group were significantly higher than those in routine group,GOS:(3.58±0.64)scores vs.(3.20±0.74)scores,(3.90±0.58)scores vs.(3.61±0.61)scores and(4.22±0.55)scores vs.(3.98±0.45)scores;KPS:(56.20±8.55)scores vs.(52.17±7.86)scores,(68.40±9.12)scores vs.(63.91±10.22)scores and(75.20±9.31)scores vs.(70.43±10.53)scores,and there were statistical differences(P<0.01 or<0.05).Conclusions Early cranioplasty after decompressive craniectomy in patients with craniocerebral injury can not only reduce the incidence of postoperative epilepsy,but also be more conducive to the recovery of postoperative neurological function and improve the prognosis of patients.
作者
范英俊
王琼芬
苗树船
刘海波
王恩任
Fan Yingjun;Wang Qiongfen;Miao Shuchuan;Liu Haibo;Wang Enren(Department of Neurosurgery,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China;Department of Rehabilitative Medicine,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China)
出处
《中国医师进修杂志》
2020年第1期45-49,共5页
Chinese Journal of Postgraduates of Medicine
基金
四川省教育厅自然科学基金(17ZA0135)。
关键词
颅脑损伤
减压颅骨切除术
手术后并发症
回顾性研究
颅骨修补
Craniocerebral trauma
Decompressive craniectomy
Postoperative complications
Retrospective studies
Cranioplasty
