颅脑外伤去骨瓣减压术后早期颅骨修补对患者神经功能及预后的影响
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摘要
目的探求颅脑外伤去骨瓣减压术后早期颅骨修补对患者神经功能及预后的影响。方法选择2015年1月至2016年9月某院行去骨瓣减压术的颅骨缺损患者98例,根据抽签法将其按1∶1方式分为两组,各49例。对照组去骨瓣减压术后>3个月行颅骨修补术治疗,观察组术后≤3个月内行颅骨修补术。随访18个月,比较两组脑灌注水平、神经功能、认知功能、生活质量评分、预后情况、并发症发生率。结果术后10 d,观察组局部脑血流量(rCBF)(87.16±6.33)mL/(100 g·min)较对照组(80.21±6.67)mL/(100 g·min)高,达峰值时间(TTP)(24.31±2.49)s较对照组(27.18±2.84)s低,术后6个月,观察组美国国立卫生研究院卒中量表(NIHSS)(7.23±2.01)分较对照组(10.32±3.41)分低,简明精神状态量表(MMSE)(81.23±7.24)分、生活质量量表(SF-36)(85.65±9.14)分较对照组(72.14±7.11)分、(73.20±8.06)分高,术后18个月,观察组格拉斯哥预后分级评分(GOS)(4.06±0.48)分、卡氏功能状态(KPS)(81.33±9.03)分均较对照组(3.56±0.61)分、(75.25±8.62)分高,差异具有统计学意义(P<0.05);观察组并发症发生率(4.08%)较对照组(16.33%)低,差异具有统计学意义(P<0. 05)。结论颅脑外伤去骨瓣减压术后早期行颅骨修补术可增加患者脑血流量,促进认知功能及神经功能恢复,降低并发症发生率,提高生活质量,改善预后。
Objective To investigate the effect of early cranioplasty after decompressive craniectomy on nerve function and prognosis in patients with craniocerebral trauma.Me thods 98 cases of craniocerebral defect with decompressive craniectomy in a hospital from January 2015 to September 2016 were selected and divided into two groups by draw lots,with 49 cases in each group.The control group was given cranioplasty 3 months after decompressive craniectomy while the observation group was treated with cranioplasty less than or equal to 3 months after decompressive craniectomy.After 18-month follow-up,the cerebral perfusion level,nerve function,cognitive function,living quality score,prognosis,incidence of complications were compared between the two groups.Re s ults 10 days after the surgery,the rC BF of the observation group[(87.16 ±6.33)mL/100(g·min)] was higher than that of the control group[(80.21 ±6.67) mL/100(g·min)].The TTP of the observation group [(24.31 ±2.49)s] was lower than that of the control group [(27.18 ±2.84)s].6 months after surgery,the NIHSS score of the observation group [(7.23 ±2.01)points] was lower than that of the control group [(10.32 ±3.41)points].The MMSE and SF-36 scores of the observation group [(81.23 ±7.24)points,(85.65 ±9.14)points] were higher than those of the control group [(72.14 ±7.11)points,(73.20 ±8.06)points].18 months after surgery,the GOS and KPS scores of the observation group [(4.06 ±0.48)points,(81.33±9.03)points] were higher than those of the control group[(3.56 ±0.61)points,(75.25±8.62)points] and the difference showed statistical significance(P <0.05).The incidence of complications in the observation group(4.08%)was lower than that of the control group(16.33%) and the difference was of statistical significance(P<0.05).Conclus ion Early cranioplasty after decompressive craniectomy in patients with craniocerebral trauma could increase cerebral blood flow,promote the recovery of cognitive function and nerve function.It could also decrease the incidence of complications,improving life quality and prognosis.
Objective To investigate the effect of early cranioplasty after decompressive craniectomy on nerve function and prognosis in patients with craniocerebral trauma.Me thods 98 cases of craniocerebral defect with decompressive craniectomy in a hospital from January 2015 to September 2016 were selected and divided into two groups by draw lots,with 49 cases in each group.The control group was given cranioplasty 3 months after decompressive craniectomy while the observation group was treated with cranioplasty less than or equal to 3 months after decompressive craniectomy.After 18-month follow-up,the cerebral perfusion level,nerve function,cognitive function,living quality score,prognosis,incidence of complications were compared between the two groups.Re s ults 10 days after the surgery,the rC BF of the observation group[(87.16 ±6.33)mL/100(g·min)] was higher than that of the control group[(80.21 ±6.67) mL/100(g·min)].The TTP of the observation group [(24.31 ±2.49)s] was lower than that of the control group [(27.18 ±2.84)s].6 months after surgery,the NIHSS score of the observation group [(7.23 ±2.01)points] was lower than that of the control group [(10.32 ±3.41)points].The MMSE and SF-36 scores of the observation group [(81.23 ±7.24)points,(85.65 ±9.14)points] were higher than those of the control group [(72.14 ±7.11)points,(73.20 ±8.06)points].18 months after surgery,the GOS and KPS scores of the observation group [(4.06 ±0.48)points,(81.33±9.03)points] were higher than those of the control group[(3.56 ±0.61)points,(75.25±8.62)points] and the difference showed statistical significance(P <0.05).The incidence of complications in the observation group(4.08%)was lower than that of the control group(16.33%) and the difference was of statistical significance(P<0.05).Conclus ion Early cranioplasty after decompressive craniectomy in patients with craniocerebral trauma could increase cerebral blood flow,promote the recovery of cognitive function and nerve function.It could also decrease the incidence of complications,improving life quality and prognosis.
引文
[1]周汉光,张东坡,张元峰.早期颅骨修补对脑损伤及脑出血术后颅骨缺损患者预后的影响[J].中国医刊,2016,51(11):86-88.
[2]王正君,姬西团.早期颅骨修补术对颅脑损伤去骨瓣减压术后神经功能及并发症的影响[J].中国临床神经外科杂志,2016,16(10):626-628.
[3]沙林,黎军,殷杰,等.颅脑损伤去骨瓣减压术后早期颅骨成形对患者神经功能及远期预后的改善作用[J].安徽医学,2015,36(6):728-731.
[4]王春晖,王君玉,李振兴,等.不同时期颅骨修补治疗颅骨缺损的疗效观察[J].第二军医大学学报,2017,38(3):335-338.
[5]吕建华,张洪兵,王刚,等.去骨瓣减压术后早期颅骨成形术对重型颅脑损伤患者神经功能恢复及预后的改善作用[J].山东医药,2015,55(15):84-85.
[6]李深誉.早期颅骨修补术对颅骨缺损患者脑灌注、神经功能、认知功能和生活质量的影响[J].神经损伤与功能重建,2017,12(6):567-568.
[7]李兆麟,钱涛.比较早/晚期行钛网数字化颅骨缺损成形术的疗效和预后[J].国际生物医学工程杂志,2015,38(1):48-51.
[8]刘宇梁,伏光辉,李凤利,等.脑外伤后早期颅骨修补术联合脑室腹腔分流术对预后的影响[J].现代中西医结合杂志,2015,24(25):2806-2808.
[9]邹钦,阳小生,吴小兵,等.早期、同期手术治疗重型颅脑损伤术后颅骨缺损并脑积水21例[J].临床外科杂志,2015,23(8):632-633.
[10]王金林,黄燕,王大永,等.高血压脑出血去骨瓣减压术后患者早期行颅骨修补术的CT灌注[J].中国老年学杂志,2017,37(16):4025-4026.
[11]庄亚瑟,方志成,刘伯毅,等.基于CT灌注评价早期钛网修补颅骨缺损对脑血流量及神经功能康复的影响:随机对照临床试验[J].中国组织工程研究,2017,21(26):4228-4233.
[12]世宏,刘科峰,吴智远,等.钛网修补颅脑损伤患者去骨瓣减压术后颅骨缺损的时机研究[J].神经损伤与功能重建,2015,10(4):352-353.
[13]赵爱国.颅骨修补对颅脑创伤患者去骨瓣减压术后并发对侧硬膜下积液的临床意义[J].中华神经外科杂志,2014,30(3):257-259.
[14]李忠,田仁富,邓国敏.不同手术方式钛网修补术对去骨瓣减压术后颅骨缺损患者预后的影响[J].现代中西医结合杂志,2017,26(4):441-443.
[15]云文科,葛茂林,王剑,等.超早期颅骨修补治疗颅骨缺损126例疗效分析[J].武警后勤学院学报(医学版),2015,24(2):132-133.
[2]王正君,姬西团.早期颅骨修补术对颅脑损伤去骨瓣减压术后神经功能及并发症的影响[J].中国临床神经外科杂志,2016,16(10):626-628.
[3]沙林,黎军,殷杰,等.颅脑损伤去骨瓣减压术后早期颅骨成形对患者神经功能及远期预后的改善作用[J].安徽医学,2015,36(6):728-731.
[4]王春晖,王君玉,李振兴,等.不同时期颅骨修补治疗颅骨缺损的疗效观察[J].第二军医大学学报,2017,38(3):335-338.
[5]吕建华,张洪兵,王刚,等.去骨瓣减压术后早期颅骨成形术对重型颅脑损伤患者神经功能恢复及预后的改善作用[J].山东医药,2015,55(15):84-85.
[6]李深誉.早期颅骨修补术对颅骨缺损患者脑灌注、神经功能、认知功能和生活质量的影响[J].神经损伤与功能重建,2017,12(6):567-568.
[7]李兆麟,钱涛.比较早/晚期行钛网数字化颅骨缺损成形术的疗效和预后[J].国际生物医学工程杂志,2015,38(1):48-51.
[8]刘宇梁,伏光辉,李凤利,等.脑外伤后早期颅骨修补术联合脑室腹腔分流术对预后的影响[J].现代中西医结合杂志,2015,24(25):2806-2808.
[9]邹钦,阳小生,吴小兵,等.早期、同期手术治疗重型颅脑损伤术后颅骨缺损并脑积水21例[J].临床外科杂志,2015,23(8):632-633.
[10]王金林,黄燕,王大永,等.高血压脑出血去骨瓣减压术后患者早期行颅骨修补术的CT灌注[J].中国老年学杂志,2017,37(16):4025-4026.
[11]庄亚瑟,方志成,刘伯毅,等.基于CT灌注评价早期钛网修补颅骨缺损对脑血流量及神经功能康复的影响:随机对照临床试验[J].中国组织工程研究,2017,21(26):4228-4233.
[12]世宏,刘科峰,吴智远,等.钛网修补颅脑损伤患者去骨瓣减压术后颅骨缺损的时机研究[J].神经损伤与功能重建,2015,10(4):352-353.
[13]赵爱国.颅骨修补对颅脑创伤患者去骨瓣减压术后并发对侧硬膜下积液的临床意义[J].中华神经外科杂志,2014,30(3):257-259.
[14]李忠,田仁富,邓国敏.不同手术方式钛网修补术对去骨瓣减压术后颅骨缺损患者预后的影响[J].现代中西医结合杂志,2017,26(4):441-443.
[15]云文科,葛茂林,王剑,等.超早期颅骨修补治疗颅骨缺损126例疗效分析[J].武警后勤学院学报(医学版),2015,24(2):132-133.