去骨瓣减压术后早期颅骨修补术对颅脑创伤患者神经功能和认知功能的影响

doi:10.3969/j.issn.1672-6731.2020.07.011

摘要/Abstract

摘要：

目的探讨早期颅骨修补术对颅脑创伤患者去骨瓣减压术后神经功能和认知功能的影响。方法 2016年1月至2019年12月共106例颅脑创伤去骨瓣减压术后行颅骨修补的患者，分为早期颅骨修补组（去骨瓣减压术后1~3个月，48例）和常规颅骨修补组（去骨瓣减压术后3~6个月，58例），分别于颅骨修补术前和术后6个月采用Glasgow预后分级（GOS）评价预后、改良Rankin量表（mRS）评价日常生活活动能力、美国国立卫生研究院卒中量表（NIHSS）评价神经功能、简易智能状态检查量表（MMSE）评价认知功能，同时记录术后6个月环锯综合征发生率。结果术后6个月时，两组患者GOS评分（P=0.000）和MMSE评分（P=0.000）均高于、mRS评分（P=0.000）和NIHSS评分（P=0.000）均低于术前；术后6个月时，早期颅骨修补组患者GOS评分（P=0.041）和MMSE评分（P=0.040）均高于、mRS评分（P=0.021）和NIHSS评分（P=0.043）均低于常规颅骨修补组，且环锯综合征发生率亦低于常规颅骨修补组［18.75%（9/48）对39.66%（23/58）；χ²=5.446，P=0.020］。结论颅脑创伤患者去骨瓣减压术后早期行颅骨修补术可以有效提高日常生活活动能力、神经功能和认知功能，减少环锯综合征的发生，改善预后和远期生活质量。

关键词: 脑损伤, 创伤性, 减压颅骨切除术, 手术后并发症, 认知障碍, 环锯综合征(非MeSH词)

Abstract:

Objective To investigate the effects of early cranioplasty on neurologic and cognitive function in patients with traumatic brain injury (TBI) after decompression of bone flap. Methods One hundred and six patients with TBI who underwent cranioplasty after decompression of bone flap were selected from January 2016 to December 2019, and were divided into early cranioplasty group (48 cases, 1-3 months after decompression) and conventional cranioplasty group (58 cases, 3-6 months after decompression). Before and 6 months after operation, Glasgow Outcome Scale (GOS), modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS) and Mini-Mental State Examination (MMSE) were utilized, and recorded syndrome of the trephine incidence of 6 months after craniotomy decompression. Results At 6 months after craniotomy decompression, GOS (P=0.000) and MMSE (P=0.000) scores of both groups were significantly higher than those before craniotomy decompression, while mRS (P=0.000) and NIHSS (P=0.000) scores were significantly lower than those before craniotomy decompression. GOS (P=0.041) and MMSE (P=0.040) scores in the early cranioplasty group were significantly higher than those in the conventional cranioplasty group, while mRS (P=0.021) and NIHSS (P=0.043) scores were significantly lower than those in the conventional cranioplasty group,and the incidence of syndrome of the trephine was also lower than that in the conventional cranioplasty group[18.75% (9/48) vs. 39.66% (23/58); χ²=5.446, P=0.020]. Conclusions Early cranioplasty for TBI patients after cranioplasty decompression with bone-removing flap can effectively improve activities of daily living, nerve function and cognitive function, reduce the incidence of syndrome of the trephine, and improve prognosis and long-term quality of life.

Key words: Brain injuries, traumatic, Decompressive craniectomy, Postoperative complications, Cognition disorders, Syndrome of the trephine (not in MeSH)

欧阳龙强, 夏文燕, 汪春晖, 杨少春, 娄建云, 邹连生, 刘鹏. 去骨瓣减压术后早期颅骨修补术对颅脑创伤患者神经功能和认知功能的影响[J]. 中国现代神经疾病杂志, 2020, 20(7): 620-624.

OUYANG Long-qiang, XIA Wen-yan, WANG Chun-hui, YANG Shao-chun, LOU Jian-yun, ZOU Lian-sheng, LIU Peng. The effect of early cranioplasty on neurologic and cognitive function in patients with traumatic brain injury after decompression of bone flap[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(7): 620-624.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I7/620

参考文献

[1] De Cola MC, Corallo F, Pria D, Lo Buono V, Calabrò RS. Timing for cranioplasty to improve neurological outcome:a systematic review[J]. Brain Behav, 2018, 8:e01106.
[2] Wettervik TS, Lenell S, Nyholm L, Howells T, Lewén A, Enblad P. Decompressive craniectomy in traumatic brain injury:usage and clinical outcome in a single centre[J]. Acta Neurochir (Wien), 2018,160:229-237.
[3] Malcolm JG, Rindler RS, Chu JK, Chokshi F, Grossberg JA, Pradilla G, Ahmad FU. Early cranioplasty is associated with greater neurological improvement:a systematic review and meta-analysis[J]. Neurosurgery, 2018, 82:278-288.
[4] Zheng F, Krischek B. Early cranioplasty:there is still much to be uncovered[J]. Clin Neurol Neurosurg, 2016, 143:162-163.
[5] Bjornson A, Tajsic T, Kolias AG, Wells A, Naushahi MJ, Anwar F, Helmy A, Timofeev I, Hutchinson PJ. A case series of early and late cranioplasty:comparison of surgical outcomes[J]. Acta Neurochir (Wien), 2019, 161:467-472.
[6] Lilja-Cyron A, Andresen M, Kelsen J, Andreasen TH, Petersen LG, Fugleholm K, Juhler M. Intracranial pressure before and after cranioplasty:insights into intracranial physiolog[J]. J Neurosurg, 2019, 18:1-11.
[7] Ashayeri K, Jackson EM, Huang J, Brem H, Gordon CR. Syndrome of the trephined:a systematic review[J].Neurosurgery, 2016, 79:525-534.
[8] Chang F, Wang X, Chang JS, Shen XM. Analysis on clinical effect of endovascular embolization and surgical clipping in the treatment of intracranial aneurysms of anterior circulation[J].Zhongguo Xian Dai Shen Jing Ji Bing Za Zhi, 2019, 19:361-366.[常枫, 王序, 常金生, 申学明. 血管内栓塞和手术夹闭治疗前循环颅内动脉瘤疗效分析[J]. 中国现代神经疾病杂志, 2019, 19:361-366.]
[9] Bai XX, Ma JX, Li YX. Innuence of the timing of hematoma puncture and catheter drainage on prognosis of patients with severe intracerebral hemorrhage[J]. Zhongguo Xian Dai Shen Jing Ji Bing Za Zhi, 2018, 18:802-806.[白新学, 马进显, 李玉星. 血肿穿刺置管引流术治疗时机对重症脑出血患者预后的影响[J]. 中国现代神经疾病杂志, 2018, 18:802-806.]
[10] Kim BW, Kim TU, Hyun JK. Effects of early cranioplasty on the restoration of cognitive and functional impairments[J]. Ann Rehabil Med, 2017, 41:354-361.
[11] Xu H, Niu C, Fu X, Ding W, Ling S, Jiang X, Ji Y. Early cranioplasty vs. late cranioplasty for the treatment of cranial defect:a systematic review[J]. Clin Neurol Neurosurg, 2015, 136:33-48.
[12] Wen L, Lou HY, Xu J, Wang H, Huang X, Gong JB, Xiong B, Yang XF. The impact of cranioplasty on cerebral blood perfusion in patients treated with decompressive craniectomy for severe traumatic brain injury[J]. Brain Inj, 2015, 29:1654-1660.
[13] Parichay PJ, Khanapure K, Joshi KC, Aniruddha TJ, Sandhya M, Hegde AS. Clinical and radiological assessment of cerebral hemodynamics after cranioplasty for decompressive craniectomy:a clinical study[J]. J Clin Neurosci, 2017, 42:97-101.
[14] Fan GF, Qin H, Wang ZL, Gao Y, Wang YX. Advances in diagnosis and treatment of syndrome of trephined and paradoxical herniation after decompressive eraniectomy[J].Zhonghua Chuang Shang Za Zhi, 2019, 35:430-434.[范国锋, 秦虎, 王增亮, 高勇, 汪永新. 去骨瓣减压术后环锯综合征和反常性脑疝特征及诊治研究进展[J]. 中华创伤杂志, 2019, 35:430-434.]
[15] Vasung L, Hamard M, Soto MCA, Sommaruga S, Sveikata L, Leemann B, Vargas MI. Radiological signs of the syndrome of the trephined[J]. Neuroradiology, 2016, 58:557-568.
[16] Chibbaro S, Vallee F, Beccaria K, Poczos P, Makiese O, Fricia M, Mateo J, Gobron C, Guichard JP, Romano A, Levy B, George B, Vicaut E. The impact of early cranioplasty on cerebral blood flow and its correlation with neurological and cognitive outcome:prospective multi-centre study on 24 patients[J]. Rev Neurol (Paris), 2013, 169:240-248.
[17] Halani SH, Chu JK, Malcolm JG, Rindler RS, Allen JW, Grossberg JA, Pradilla G, Ahmad FU. Effects of cranioplasty on cerebral blood flow following decompressive craniectomy:a systematic review of the literature[J]. Neurosurgery, 2017, 81:204-216.
[18] Honeybul S. Neurological susceptibility to a skull defect[J].Surg Neurol Int, 2014, 5:83.
[19] Wang K, Li B, Zhao P, Fan YS, Zang JM, Zhang SH, Wang DQ. Curative effect and complication of cranioplasty at different periods after standard bone flap decompression[J]. Zhonghua Shen Jing Chuang Shang Wai Ke Dian Zi Za Zhi, 2018, 4:77-81.[王坤, 李冰, 赵鹏, 樊永帅, 臧家蒙, 张少虎, 王东起. 标准大骨瓣减压术后不同时期行颅骨修补术的疗效及并发症观察[J]. 中华神经创伤外科电子杂志, 2018, 4:77-81.]
[20] Huang YH, Lee TC, Yang KY, Liao CC. Is timing of eranioplasty following posttraumalic craniectomy related to neurological outcome[J]? Int J Surg, 2013, 11:886-890.

选择文件类型/文献管理软件名称

选择包含的内容

2 去骨瓣减压术后早期颅骨修补术对颅脑创伤患者神经功能和认知功能的影响

The effect of early cranioplasty on neurologic and cognitive function in patients with traumatic brain injury after decompression of bone flap

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	万亚会, 吕梦頔, 李征, 周凯丽, 高海静, 薛蓉. 慢性失眠合并阻塞性睡眠呼吸暂停患者睡眠结构和自主神经功能特征及其与神经心理特征相关分析[J]. 中国现代神经疾病杂志, 2023, 23(8): 693-708.
[2]	贾亮, 周航, 张晓炜, 张庆九, 吕中强. 内镜下扩大经鼻入路手术切除鞍上侵袭性垂体腺瘤[J]. 中国现代神经疾病杂志, 2023, 23(7): 586-590.
[3]	邹婷婷, 马莉, 潘文静, 李长秀, 胡乃霞, 王擂. 重型颅脑创伤并发颅内感染危险因素分析及列线图预测模型构建[J]. 中国现代神经疾病杂志, 2023, 23(6): 496-502.
[4]	张檀, 丁钰, 袁利群. 直视下经皮扩张气管切开术在神经外科重症患者中的应用[J]. 中国现代神经疾病杂志, 2023, 23(6): 503-508.
[5]	罗玲, 陈荣华, 肖迎春, 余尔涵, 潘晓东. 特发性快速眼动睡眠期行为障碍患者认知功能特点及其与睡眠结构相关性分析[J]. 中国现代神经疾病杂志, 2023, 23(6): 549-559.
[6]	冯增伟, 丁平, 廖先文, 焦永辉, 左云龙, 韩宏彦. 烟雾病脑血管重建术后发生脑过度灌注综合征的临床分析[J]. 中国现代神经疾病杂志, 2023, 23(5): 460-466.
[7]	刘庆, 孙萍. 主观认知下降临床研究进展[J]. 中国现代神经疾病杂志, 2023, 23(4): 275-281.
[8]	余彩遥, 叶兰, 冯占辉. 癫痫患者认知功能障碍相关危险因素研究进展[J]. 中国现代神经疾病杂志, 2023, 23(4): 287-291.
[9]	苏玉洁, 孙嫣, 凌怡, 张侃, 刘晓燕, 彭国平. 老年轻度认知损害患者抑郁情绪与认知功能相关性分析[J]. 中国现代神经疾病杂志, 2023, 23(4): 292-302.
[10]	孙艳, 范茹雪, 陈慧丰, 尹洁, 张楠. 天津市部分城市社区老年人群轻度认知损害患病情况及影响因素分析[J]. 中国现代神经疾病杂志, 2023, 23(4): 303-309.
[11]	乔雨晨, 常红, 王佳妹, 杨璇, 魏娜, 丁爱聪. 认知功能障碍患者激越行为特点及影响因素分析[J]. 中国现代神经疾病杂志, 2023, 23(4): 310-316.
[12]	姚莉萍, 王睿晗, 包翌, 蔡瀚林, 陈芹. 后部皮质萎缩临床及影像学特征分析[J]. 中国现代神经疾病杂志, 2023, 23(4): 326-334.
[13]	杨辉, 王伟. 以进行性记忆力减退为主要表现的后部皮质萎缩一例[J]. 中国现代神经疾病杂志, 2023, 23(4): 341-345.
[14]	宋云飞, 赵岩, 贾晓丹, 孙超, 杨树源, 杨新宇. 颞浅动脉-大脑中动脉搭桥术联合脑-颞肌贴敷术对烟雾病患者认知功能的影响[J]. 中国现代神经疾病杂志, 2022, 22(9): 805-809.
[15]	曹泽岗, 夏刚, 万军, 崔子健, 田融, 徐天同. 颈椎前路椎间盘切除椎间融合术：零切迹自锁式椎间融合系统与传统融合器联合钛板内固定对比分析[J]. 中国现代神经疾病杂志, 2022, 22(8): 687-695.

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

2 去骨瓣减压术后早期颅骨修补术对颅脑创伤患者神经功能和认知功能的影响

The effect of early cranioplasty on neurologic and cognitive function in patients with traumatic brain injury after decompression of bone flap

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价