Zhang Guo-liang, Yang Wei-zhong, Jiang Yan-wei, Zeng Tao
Neurosurgery Department, Affiliated Union Hospital, Fujian Medical University, Fuzhou 350001, China.
Chin J Traumatol. 2010 Oct 1;13(5):259-64.
To compare the effect of extensive duraplasty and subsequent early cranioplasty on the recovery of neurological function in management of patients with severe traumatic brain injuries received decompressive craniectomy.
The computer-aided designation of titanium armor plate was used as a substitute for the repair of skull defect in all the patients. The patients were divided into three groups. Twenty-three patients were in early cranioplasty group who received extensive duraplasty in craniectomy and subsequent cranioplasty within 3 months after previous operation (Group I). Twenty-one patients whose cranioplasty was performed more than 3 months after the first operation were in the group without duraplasty (Group II); while the other 26 patients in the group with duraplasty in previous craniotomy (Group III). Both the Barthel index of activity of daily living (ADL) 3 months after craniotomy for brain injuries and 1 month after cranioplasty and Karnofsky Performance Score (KPS) at least 6 months after cranioplasty were assessed respectively.
The occurrence of adverse events commonly seen in cranioplasty, such as incision healing disturbance, fluid collection below skin flap, infection and onset of postoperative epilepsy was not significantly higher than other 2 groups. The ADL scores at 3 months after craniotomy in Groups I-III were 58.9 ± 26.7, 40.8 ± 20.2 and 49.2 ± 18.6. The ADL scores at 1 month after cranioplasty were 70.2 ± 25.2, 50.8 ± 24.8 and 61.2 ± 21.5. The forward KPS scores were 75.4 ± 19.0, 66.5 ± 24.7 and 57.6 ± 24.7 respectively. The ADL and KPS socres were significantly higher in group I than other 2 groups.
The early cranioplasty in those with extensive duraplasty in previous craniotomy is feasible and helpful to improving ADL and long-term quality of life in patients with severe traumatic brain injuries.
比较在接受减压性颅骨切除术的重型颅脑损伤患者的治疗中，广泛硬脑膜成形术及随后的早期颅骨成形术对神经功能恢复的影响。
所有患者均采用计算机辅助设计的钛制颅骨修复板修复颅骨缺损。患者分为三组。23例患者为早期颅骨成形术组，在颅骨切除术中接受广泛硬脑膜成形术，并在首次手术后3个月内进行颅骨成形术（I组）。21例患者在首次手术后3个月以上进行颅骨成形术，为无硬脑膜成形术组（II组）；另外26例患者在先前开颅手术中有硬脑膜成形术（III组）。分别评估脑损伤开颅术后3个月、颅骨成形术后1个月的日常生活活动能力（ADL）Barthel指数以及颅骨成形术后至少6个月的卡氏功能状态评分（KPS）。
颅骨成形术中常见的不良事件，如切口愈合障碍、皮瓣下积液、感染及术后癫痫发作的发生率，I组并不显著高于其他两组。I - III组开颅术后3个月的ADL评分分别为58.9±26.7、40.8±20.2和49.2±18.6。颅骨成形术后1个月的ADL评分分别为70.2±25.2、50.8±24.8和61.2±21.5。KPS评分分别为75.4±19.0、66.5±24.7和57.6±24.7。I组的ADL和KPS评分显著高于其他两组。
对于先前开颅术中进行广泛硬脑膜成形术的患者，早期颅骨成形术是可行的，有助于改善重型颅脑损伤患者的ADL及长期生活质量。
