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.

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

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

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