Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Int J Surg. 2013;11(9):886-90. doi: 10.1016/j.ijsu.2013.07.013. Epub 2013 Aug 7.
With the use of decompressive craniectomy for traumatic brain injury (TBI) come a corresponding number of cranioplasties. TBI causes dynamic processes to commence or change during the period from injury to recovery; hence, the role of the timing of surgical intervention should be emphasized.
We attempt to identify the relationship between the timing of cranioplasty and neurological outcomes following posttraumatic craniectomy.
In this 3-year retrospective study, 105 patients undergoing decompressive craniectomies and subsequent cranioplasties for TBI were enrolled. We documented the patients' demographic information, including Glasgow Coma Scale (GCS) at admission for trauma. The follow-up period was terminated by death or a minimum of 6 months after TBI. Glasgow Outcome Scale (GOS) at the end of follow-up was used as an outcome measure. Unfavorable outcome was defined as a GOS score of 1-3.
The 105 patients included 71 male and 34 female subjects. The mean age was 41.94 ± 19.73 years. Neurological assessment showed that admission GCS was 8.50 ± 3.15, on average. The mean time interval between cranioplasty and craniectomy was 78.84 ± 49.04 days (range, 13-245 days). Univariate logistic regression analysis showed that the association between the timing of cranioplasty and unfavorable outcomes was not statistically significant (odds ratio = 1.005, confidence interval 0.997-1.013; p = 0.195).
The timing of cranioplasty following posttraumatic craniectomy was not related to the neurological outcomes of TBI. Despite the limitations of the retrospective design, the analyses provide preliminary information to elucidate the question.
随着创伤性脑损伤（TBI）减压性颅骨切除术的应用，相应数量的颅骨修补术也随之而来。TBI 导致在从受伤到恢复的过程中开始或改变动态过程；因此，手术干预时机的作用应该得到强调。
我们试图确定创伤性颅骨切除术后颅骨修补术时机与神经结局之间的关系。
在这项为期 3 年的回顾性研究中，纳入了 105 例因 TBI 行减压性颅骨切除术和随后颅骨修补术的患者。我们记录了患者的人口统计学信息，包括创伤性入院时的格拉斯哥昏迷量表（GCS）评分。随访期以死亡或 TBI 后至少 6 个月结束。使用格拉斯哥结局量表（GOS）作为结局测量。预后不良定义为 GOS 评分为 1-3。
105 例患者中，男 71 例，女 34 例。平均年龄为 41.94±19.73 岁。神经评估显示，入院时 GCS 平均为 8.50±3.15。颅骨修补术与颅骨切除术之间的平均时间间隔为 78.84±49.04 天（范围 13-245 天）。单因素 logistic 回归分析显示，颅骨修补术时机与不良结局之间的关联无统计学意义（比值比=1.005，95%置信区间 0.997-1.013；p=0.195）。
创伤性颅骨切除术后颅骨修补术的时机与 TBI 的神经结局无关。尽管回顾性设计存在局限性，但分析结果提供了初步信息，以阐明这一问题。
