Sun Shengli, Li Jiangyang, Deng Yongwen, Gong Shuhui, Tao Meiyi
Department of Neurosurgery, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, PR China.
Department of Nursing, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, PR China.
World Neurosurg. 2024 Nov;191:e144-e150. doi: 10.1016/j.wneu.2024.08.082. Epub 2024 Aug 19.
Craniocerebral trauma is one of the main causes of death and disability worldwide. Decompressive craniectomy is a common emergency measure in the treatment of craniocerebral trauma, aimed at relieving intracranial pressure. However, cranial bone reconstruction (CP) following this surgery is crucial for the patient's long-term recovery. Despite this, research on complications and prognostic factors after ultra-early cranioplasty remains limited. Therefore, this study aims to explore the complications of ultra-early cranioplasty with titanium mesh and its impact on prognosis.
From January 2020 to November 2022, 44 patients with craniocerebral trauma who needed ultra-early CP after decompressive craniectomy were collected. The basic data of the National Institutes of Health Stroke Scale (NIHSS), Glasgow Coma Scale, modified Rankin Scale, and Montreal Cognitive Assessment scores of patients were collected, and the complications and prognosis of patients 3 months after operation were collected. Multivariate logistic regression was used to analyze the prognostic factors.
Compared with preoperative, the postoperative NIHSS score of patients with ultra-early CP decreased, the postoperative Glasgow Coma Scale score increased, the postoperative modified Rankin Scale score decreased (P < 0.05), and the postoperative Montreal Cognitive Assessment score was higher. Postoperative complications occurred in 42 patients with ultra-early CP. There were 37 complications, including 7 cases of hydroaccumulation, 18 cases of hematocele, 11 cases of pneumatosis, 3 cases of scalp swelling, 2 cases of epilepsy, 10 cases of hydrocephalus, and 1 case of intracranial infection, and no incision infection occurred. Age and postoperative NIHSS score were related factors affecting the poor prognosis of ultra-early CP patients (P < 0.05).
Ultra-early CP can promote the recovery of neurological function, reduce the disturbance of consciousness, improve daily living ability, and improve cognitive function in patients with craniocerebral trauma, but there is a high risk of postoperative complications. In addition, age and postoperative NIHSS score are related factors affecting the poor prognosis of ultra-early CP patients.
颅脑创伤是全球范围内死亡和致残的主要原因之一。去骨瓣减压术是治疗颅脑创伤的常见急救措施，旨在缓解颅内压。然而，该手术后的颅骨重建（CP）对患者的长期康复至关重要。尽管如此，超早期颅骨修补术后并发症及预后因素的研究仍然有限。因此，本研究旨在探讨钛网超早期颅骨修补术的并发症及其对预后的影响。
收集2020年1月至2022年11月44例颅脑创伤患者，这些患者在去骨瓣减压术后需要进行超早期CP。收集患者的美国国立卫生研究院卒中量表（NIHSS）、格拉斯哥昏迷量表、改良Rankin量表和蒙特利尔认知评估评分的基础数据，并收集患者术后3个月的并发症及预后情况。采用多因素logistic回归分析预后因素。
与术前相比，超早期CP患者术后NIHSS评分降低，格拉斯哥昏迷量表评分升高，改良Rankin量表评分降低（P<0.05），蒙特利尔认知评估评分升高。42例超早期CP患者发生术后并发症。并发症共37例，包括积液7例、血肿18例、积气11例、头皮肿胀3例、癫痫2例、脑积水10例、颅内感染1例，未发生切口感染。年龄和术后NIHSS评分是影响超早期CP患者预后不良的相关因素（P<0.05）。
超早期CP可促进颅脑创伤患者神经功能恢复，减少意识障碍，提高日常生活能力，改善认知功能，但术后并发症风险较高。此外，年龄和术后NIHSS评分是影响超早期CP患者预后不良的相关因素。
