Satardey Ritesh S, Balasubramaniam Srikant, Pandya Jayashree S, Mahey Rajesh C
Department of General Surgery, TN Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India.
Department of Neurosurgery, TN Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India.
Asian J Neurosurg. 2018 Apr-Jun;13(2):341-347. doi: 10.4103/ajns.AJNS_117_16.
The outcome of patients with depressed fracture varies and depends on multiple factors. There has been no previous study on the significance of these factors on the outcome of depressed fracture of the skull and hence this study. Aims: The primary aim of our study is to find the factors affecting the outcome in cases of depressed skull fracture (DSF). This will help us improve outcomes and give more accurate prediction of long-term outcomes.
Prospective observational study.
Institutional Ethics Committee approval was taken for doing this observational study. This was conducted in a tertiary care institute by collecting data of fifty cases of DSFs in 2 years, between January 2012 and December 2013. The study included patients who were diagnosed with DSFs admitted to our tertiary care public hospital. Patients with comorbidity involving injury to other organs or medical disorders and pediatric patients were excluded from our study.
Chi-square test and Fisher exact test. Results: There was a statistically significant impact on age, sex, Glasgow Coma Scale (GCS) score at presentation, type of DSF, and site of DSF in the long-term outcome of patients. The patients with GCS score of 13 or more fared well with good long-term outcome as against those with GCS score below it. Any additional brain injury in the form of hematomas, etc., has a significant negative impact on long-term outcome of the patient and warrant urgent surgical intervention. Complications such as dural tear, cerebral contusions, wound infections, and seizures have adverse effect on the recovery.
Our observation suggests that patients brought to hospital with minimal delay, with GCS score between 13 and 15, with simple DSF and normal brain parenchyma without dural tear, have the best outcome.
凹陷性骨折患者的预后各不相同，且取决于多种因素。此前尚无关于这些因素对颅骨凹陷性骨折预后意义的研究，因此开展了本研究。目的：我们研究的主要目的是找出影响凹陷性颅骨骨折（DSF）患者预后的因素。这将有助于我们改善预后，并对长期预后做出更准确的预测。
前瞻性观察性研究。
进行这项观察性研究已获得机构伦理委员会的批准。本研究在一家三级医疗机构开展，收集了2012年1月至2013年12月期间50例DSF患者的两年数据。该研究纳入了在我们三级护理公立医院确诊为DSF并入院的患者。合并有其他器官损伤或内科疾病的患者以及儿科患者被排除在我们的研究之外。
卡方检验和费舍尔精确检验。结果：年龄、性别、入院时的格拉斯哥昏迷量表（GCS）评分、DSF类型和DSF部位对患者的长期预后有统计学上的显著影响。GCS评分为13分及以上的患者长期预后良好，而评分低于13分的患者则不然。任何以血肿等形式出现的额外脑损伤对患者的长期预后有显著负面影响，需要紧急手术干预。硬膜撕裂、脑挫伤、伤口感染和癫痫等并发症对恢复有不利影响。
我们的观察表明，就诊延迟最短、GCS评分在13至15分之间、DSF简单且脑实质正常无硬膜撕裂的患者预后最佳。
