Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Western Australia.
J Neurotrauma. 2010 Jul;27(7):1225-32. doi: 10.1089/neu.2010.1316.
A number of studies have shown that decompressive craniectomy can reduce intracranial pressure and may improve outcome for patients with severe head injury. This cohort study assessed the long-term outcome of neurotrauma patients who had a decompressive craniectomy for severe head injury in Western Australia between 2004 and 2008. The web-based outcome prediction model developed by the CRASH trial collaborators was applied to the cohort. Predicted outcome and observed outcome were compared. Characteristics of outcome between those who had had a unilateral and those who had had a bilateral decompressive procedure were compared. All complications were recorded. Among a total of 1,786 adult neurotrauma patients admitted during the study period, 147 patients (8.2%) had a decompressive craniectomy. A significant proportion of patients who required unilateral (37.3%) and bilateral (46.5%) craniectomy were able to return to work or study at 18 months after the injury. The patients who required bilateral craniectomy more likely to be associated with an unfavorable outcome (Glasgow Outcome Scale score >or=3) than those who had unilateral craniectomy (odds ratio 4.42; 95% confidence interval 1.16,16.81; p = 0.029), after adjusting for the timing of surgery, mechanism of injury, and the predicted risk of unfavorable outcome. The functional outcome after either unilateral or bilateral decompressive craniectomy was significantly better than that predicted by the CRASH head injury prediction model when the predicted risk was less than 80%. This study has demonstrated that in Western Australia decompressive craniectomy is a relatively common surgical procedure for the management of neurotrauma. A significant proportion of patients had a better-than-predicted long-term functional outcome.
多项研究表明，去骨瓣减压术可以降低颅内压，并可能改善严重颅脑损伤患者的预后。本队列研究评估了 2004 年至 2008 年期间在西澳大利亚因严重颅脑损伤接受去骨瓣减压术的神经创伤患者的长期预后。应用 CRASH 试验协作组开发的基于网络的预后预测模型对该队列进行分析。比较预测结果和观察结果。比较单侧和双侧去骨瓣减压术患者的结局特征。记录所有并发症。在研究期间共收治 1786 例成年神经创伤患者中，有 147 例（8.2%）接受了去骨瓣减压术。需要单侧（37.3%）和双侧（46.5%）去骨瓣减压术的患者中，相当一部分能够在受伤后 18 个月恢复工作或学习。需要双侧去骨瓣减压术的患者与单侧去骨瓣减压术患者相比，更有可能出现不良预后（格拉斯哥预后评分>或=3）（比值比 4.42；95%置信区间 1.16，16.81；p=0.029），调整手术时机、损伤机制和不良预后的预测风险后。当预测风险小于 80%时，单侧或双侧去骨瓣减压术后的功能结局明显优于 CRASH 颅脑损伤预测模型的预测结果。本研究表明，在西澳大利亚，去骨瓣减压术是神经创伤管理中一种相对常见的手术方法。相当一部分患者的长期功能预后好于预测结果。
