Yan Zhifeng, Xue Zecheng, Wang Maolin, Wang Linjun, Che Hongmin, Yan Zhongnan
Department of Neurosurgery, The First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China.
Xi'an Medical University, Xi'an, Shaanxi, China.
BMC Surg. 2025 May 13;25(1):205. doi: 10.1186/s12893-025-02943-4.
A growing cohort of malignant cerebral infarction (MCI) patients after decompressive craniectomy (DC) required cranioplasty (CP). However, few studies have reported the effect of CP on functional improvements in post-DC MCI patients. The aim of this study was to determine whether early CP for post-DC MCI patients enhances surgical outcomes and alters overall complication rate.
86 post-DC MCI patients after CP were divided into the early CP cohort and the traditional CP cohort according to the time span from DC to CP. Complications, NIHSS, mBI, mRS, and CRS-r were assessed, and early CP and traditional CP were defined as occurring less than or more than 3 months after DC.
Complications were observed in 9 patients (24.32%) in the early CP cohort and 14 patients (28.57%) in the traditional CP cohort (p > 0.05). NIHSS, mRS, mBI, and CRS-r between pre-operation and post-operation did significantly differ (p < 0.05). Between the two cohorts, operative time, intraoperative blood loss, post-operative parameters (NIHSS, mBI and mRS), ∆NIHSS, and ∆mBI did significantly differ (p < 0.05), while post-operative CRS-r did not significantly differ (p > 0.05). There was a linear relationship between ∆NIHSS and the time span from DC to CP (r = 0.505, p < 0.0001), and there was a linear relationship between ∆BI and the time span from DC to CP (r = -0.568, p < 0.0001).
Our study demonstrated that, first, CP has a favorable effect on improving neurological function, ability to perform daily living, and consciousness in post-DC MCI patients; second, early CP does not alter the overall complication rate and is as safe as traditional CP; third, compared to traditional CP, early CP reduces operative time and intraoperative blood loss, promotes improvements in neurological function and ability to perform daily living, and enhances these improvements.
越来越多的减压颅骨切除术后恶性脑梗死（MCI）患者需要进行颅骨修补术（CP）。然而，很少有研究报道CP对减压颅骨切除术后MCI患者功能改善的影响。本研究的目的是确定早期CP对减压颅骨切除术后MCI患者是否能提高手术效果并改变总体并发症发生率。
86例接受CP的减压颅骨切除术后MCI患者根据从减压颅骨切除术到CP的时间间隔分为早期CP组和传统CP组。评估并发症、美国国立卫生研究院卒中量表（NIHSS）、改良Barthel指数（mBI）、改良Rankin量表（mRS）和昏迷恢复量表修订版（CRS-r），并将早期CP和传统CP定义为在减压颅骨切除术后少于或多于3个月发生。
早期CP组9例（24.32%）和传统CP组14例（28.57%）观察到并发症（p>0.05）。术前和术后的NIHSS、mRS、mBI和CRS-r有显著差异（p<0.05）。两组之间，手术时间、术中出血量、术后参数（NIHSS、mBI和mRS）、NIHSS变化值（∆NIHSS）和mBI变化值有显著差异（p<0.05），而术后CRS-r无显著差异（p>0.05）。∆NIHSS与从减压颅骨切除术到CP的时间间隔之间存在线性关系（r=0.505，p<0.0001），∆BI与从减压颅骨切除术到CP的时间间隔之间存在线性关系（r=-0.568，p<0.0001）。
我们的研究表明，第一，CP对改善减压颅骨切除术后MCI患者的神经功能、日常生活能力和意识有积极作用；第二，早期CP不会改变总体并发症发生率，与传统CP一样安全；第三，与传统CP相比，早期CP可减少手术时间和术中出血量，促进神经功能和日常生活能力的改善，并增强这些改善。
