关键词: 重型颅脑外伤, 去骨瓣减压术, 颅骨修补, 脑血流动力学, 预后

Abstract: Objective To investigate the effect of early cranioplasty after decompressive craniectomy(DC) for patients with traumatic brain injury(STBI) and influence on cerebral hemodynamics.
Methods 124 STBI patients after DC operation were collected and randomly divided into two groups:observation group(n=59) underwent early cranioplasty(1 to 3 months after DC operation),and control group(n=65) underwent late cranioplasty(3 to 6 months after DC operation).The postoperative complications,the National Institutes of Health Stroke Scale(NIHSS) score,Barthel Index(BI) and Glasgow Outcome Scale(GOS) score were compared between the two groups.The average blood flow velocity(Vm) of the middle cerebral artery(MCA),the regional cerebral blood flow(CBF),cerebral blood volume(CBV),time to peak(TTP),and mean transit time(MTT) in the cerebral cortex,basal ganglia and thalamus were measured before and 14 days after surgery.
Results 14 days after the surgery,the Vm of MCA at injured side and uninjured side of the observation group was(70.13±9.25)cm/s and(69.45±9.96)cm/s,the control groups was(66.17±7.82)cm/s and(67.86±9.63)cm/s,both groups were significantly higher than before surgery,and the Vm at injured side of the observation group was significantly higher than that of the control group(P＜0.05).At 14 days after surgery,the changes of CBF in the cerebral cortex,basal ganglia and thalamus in the observation group was(29.88±6.32),(8.87±2.61) and(7.61±1.64) [ml/(100 g·min)],both higher than(19.84±5.13),(4.15±1.15) and(5.37±1.52) [ml/(100 g·min)] in the control group(P＜0.05);the changes of CBV in the cerebral cortex,basal ganglia and thalamus in the observation group were(3.81±0.64)ml/100g and(1.11±0.33)ml/100g,which were higher than(1.62±0.52)ml/100g and(0.47±0.15)ml/100g in the control group(P＜0.05);the changes of TTP values in the cerebral cortex and basal ganglia of the observation group were -(5.22±1.06)s and -(3.50±0.56)s,which were higher than the control group[-(2.78±0.85)s and-(1.99±0.51)s](P＜0.05),but the difference in MTT changes between the two groups was not significant(P>0.05).At 3 months after surgery,the NIHSS score of the observation group was(3.73±0.56) points,which was significantly lower than(4.02±0.71) points of the control group(P＜0.05).The BI and GOS scores were(85.83±6.79) points and(4.05±0.45) points,respectively,which were significantly higher than(80.12±6.14) points and(3.72±0.41) points of the control group(P＜0.05).The excellent rate of prognosis of the observation group was 88.14%,which was significantly higher than 75.38% of the control group(P＜0.05).The postoperative complication rate of the observation group was 8.47%,there was no statistically significant difference compared with 10.77% of the control group(P>0.05).
Conclusion Early cranioplasty after DC for STBI patients is beneficial to improve cerebral hemodynamics,promote the recovery of nerve function and improve clinical prognosis.

Key words: severe craniocerebral trauma, decompressive craniectomy, cranioplasty, cerebral hemodynamics, prognosis