早期颅骨修补对颅脑创伤患者预后的影响  

The effect of early cranioplasty on prognosis of patients with decompressive craniectomy due to head trauma

作　　者：李谷[1] 温良[1] 杨小锋[1] 龚江标[1] 詹仁雅[1] 王芳[1] 潘露萍[1] 刘伟国[2] 

机构地区：[1]浙江大学医学院附属第一医院神经外科,杭州310003 [2]浙江大学医学院附属第二医院神经外科

出　　处：《中华神经外科杂志》2008年第10期750-752,共3页Chinese Journal of Neurosurgery

摘　　要：目的分析颅脑创伤后去骨瓣减压术后早期颅骨修补对患者长期功能预后的影响。方法采用回顾性病例对照研究的方法比较颅脑创伤去骨瓣减压术后行早期的颅骨修补术（〈2个月）患者与术后行常规颅骨修补术（〉3个月）患者长期预后的差异，从而评价早期颅骨修补对于颅脑创伤行去骨瓣减压术患者的预后影响。早期颅骨修补组与延期颅骨修补组各23例，病例根据性别、年龄、颅脑创伤的严重程度及修补术前预后水平1：1配对。结果比较外伤后15个月患者的预后水平，早期颅骨修补组（GOS：4．3±0．9；KPS：73．9±22．5）较延期颅骨修补组（GOS：3．8±1．0；KPS：62．6±24．2）有显著提高。结论在掌握适应证的情况下去骨瓣减压后早期行颅骨修补术对患者预后的改善安全有效。Objectives This study was performed to ascertain whether early cranioplasty could improve the outcomes in patients with large cranial defects resulted from decompressive surgery after severe head trauma. Methods In this study, a case control cohort study was performed to compare the outcomes of the patients （23 cases） who underwent early cranioplasty ranged from 5 to 8 weeks （ 〈 2 months ） after decompressive craniectomy due to severe traumatic brain injuries with those of the patients （23 cases ） undergoing the same procedure within a traditional duration. The data of age, gender and severity of the head trauma were well compared between early cranioplasty group and delayed cranioplasty group. Results There were no differences in patients＇ demographics, degree of head trauma, types of CT classification, therapy intensity level, size of cranial defects, complications secondary to cranioplasty and therapy for rehabilitation between two groups as well. And 15 months after head trauma, the prognosis of early cranioplasty group （ GOS ：4.3±0.9 ; KPS ：73.9 ± 22.5 ） was better than that of delayed cranioplasty group （ GOS ： 3.8 ± 1.0 ; KPS ： 62.6 ± 24.2 ） with significant differences statistically （ GOS ： P = 0.022 ; KPS ： P = 0.035 ）. Conclusion Early eranioplaty for large cranial defects by decompressive eraniectomy is safe and helpful to improve the patients＇ prognosis, and may contribute to better outcomes than late cranioplasty.

关 键 词：颅脑损伤 去骨瓣减压 颅骨修补 预后 

分 类 号：R686[医药卫生—骨科学]