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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(P>0.05);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(P<0.05)。超早期组患者头皮剥离时间较常规修补组明显缩短(P<0.05),出血量明显减少(P<0.05);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(P<0.05),然而总体并发症发生率并无明显差异(P>0.05)。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。
Objective: To investigate the feasibility and clinical effect of three-dimensional titanium mesh skull repair in patients with craniocerebral injury after craniocerebral trauma decompression surgery in the very early stage (4-6 weeks), and to explore the effect of ultra-early skull repair surgery In the presence of more advantages than conventional surgery. Methods: A retrospective analysis of 99 cases of craniofacial defects after traumatic brain injury repaired from January 2012 to January 2015 was performed. All patients were divided into two groups according to the interval of skull repair after decompressive craniectomy. Within 4-6 weeks, they were ultra-early group, a total of 52 cases, 3-6 months for the conventional group, a total of 47 cases. The quality of life of the two groups of patients at 1 month, 3 months and 12 months after cranioplasty was compared by using different international scoring standards. The intraoperative scalp exfoliation time and intraoperative blood loss were compared between the two groups. Postoperative 1 month, 3 months, 12 months, the corresponding complications. Results: Glasgow outcome scale (GOS), National Institutes of Health NHSS score and Karnofsky performance status (KPS) scores of patients in ultra-early group were significantly higher than those of conventional (P> 0.05). The scores of GOS, NIHSS and KPS at 3 months and 12 months after operation in the ultra-early group were significantly higher than those in the conventional group (P <0.05). The scalp exfoliation time in ultra-early group was significantly shorter than that in routine repair group (P <0.05), and the amount of bleeding was significantly reduced (P <0.05). The incidence of subdural effusion in skull repair group was significantly lower (P <0.05), however, there was no significant difference in the overall complication rate (P> 0.05). CONCLUSIONS: It is clinically safe and effective for patients with severe traumatic brain injury after decompressive craniectomy to perform skull repair in very early stage (4-6 weeks), which can improve the prognosis of patients and reduce the incidence of postoperative complications. And can reduce intraoperative bleeding, surgery, scalp peeling time also shortened.