超早期三维钛网颅骨修补术的临床研究

目的:探讨重型颅脑损伤去骨瓣减压手术后颅骨缺损在超早期(4~6周内)行三维钛网颅骨修补的可行性和对患者长期预后的影响,探讨超早期颅骨修补术手术中是否较常规手术存在优势。方法:回顾性分析自2012年1月-2015年1月行颅脑损伤后颅骨缺损手术修补患者99例。将所有患者根据去骨瓣减压术后行颅骨修补的间隔时间分为两组,4-6周以内为超早期组,共52例,3-6个月为常规组,共47例。采用不同国际评分标准比较两组患者在颅骨修补术后1个月、3个月、12个月的生存质量;对比分析两组患者的术中头皮剥离时间及术中出血量;比较两组患者术后1个月、3个月、12个月相应并发症的差异。结果:超早期组患者术后1个月的格拉斯哥评分(Glasgow outcome scale,GOS)、美国国立卫生院神经功能缺损评分(NIHSS)和远期卡氏功能状态(Karnofsky performance status,KPS)评分较常规组比较无统计学意义(P0.05);超早期组患者术后3个月和12个月的GOS、NIHSS和KPS评分较常规组均有显著提高(P0.05)。超早期组患者头皮剥离时间较常规修补组明显缩短(P0.05),出血量明显减少(P0.05);两组颅骨修补术后硬膜下积液发生率明显降低,差异有统计学意义(P0.05),然而总体并发症发生率并无明显差异(P0.05)。结论:重度颅脑损伤去骨瓣减压术后患者在超早期(4~6周内)行颅骨修补在临床上是安全有效的,能够改善患者的预后和减少术后并发症的发生概率,并且能够减少术中出血,手术中头皮剥离时间也有缩短。

Ultra Craniectomy Early Clinical Study Three-dimensional Titanium Mesh Skull Repair Surgery Reduced Pressure

ABSTRACT Objective: To investigate the severe brain injury after decompressive surgery of skull defects ultra-early (4-6 weeks) the feasibility of row three-dimensional titanium mesh skull patch and its impact on the long-term prognosis of patients, and to explore ul- tra-early skull repair surgery Are compared with conventional surgery exist advantages. Methods: A retrospective analysis from January 2012 - January 2015 after the Brain Injury skull defect repair surgery 99 patients all patients after decompression interval skull patch into two groups according to craniectomy, 4. within -6 weeks for ultra-early group, 52 cases, 3-6 months for the conventional group, 47 cases. Skull patch after 1 month, 3 months, quality of life between the two groups of patients with different international scoring 12 months; comparative analysis peeling scalp surgery time and blood loss between the two groups; two groups were compared after 1 month, 3 months, 12 months, corresponding to the difference complications. Results: Ultra-early group patients after one month of GCS (Glasgow outcome scale, GOS), the US National Institutes of Health neurological deficits (NIHSS) and long-term Karnofsky functional status (Karnofsky performance status, KPS) score compared with the conventional group no significant difference (P>0.05); super-early group patients 3 months and 12 months of GOS, NIHSS and KPS scores were significantly increased (P<0.05) than the conventional group. Pa- tients with ultra-early scalp skull patch set release time than conventional repair group was significantly shorter (P<0.05), the amount of bleeding was significantly reduced (P<0.05); the next two cranioplasty subdural effusion were significantly lower, the difference statistics significance (P<0.05). However, the overall complication rate was no significant difference (P>0.05). Conclusion: Severe brain injury pa- tients after decompression craniectomy in the ultra-early (4-6 weeks) skull patch is clinically safe and effective, it can improve patient outcomes and reduce the probability of occurrence of postoperative complications, and can reduce blood loss during surgery scalp peeling time shortened.