重型颅脑损伤后颅骨缺损患者行超早期颅骨修补对患者预后的临床研究
A Clinical Study on the Prognosis of Patients with Skull Defects after Severe Craniocerebral Injury by Super Early Cranial Repair

目的：颅脑损伤具有较高的致残率和死亡率。颅骨成形术时机的选择对患者的预后有非常重要的影响。因此，本文旨在比较超早期修复与常规修复的功能预后状况。方法：对2017年1月至2020年1月间招募的60例重症颅脑外伤术后行颅骨成形术的患者进行前瞻性研究。根据颅脑损伤术后修复时间将所有患者分为超早期组(术后4~6周修补，28例)和常规组(术后3~6个月修补，32例)。记录性别、年龄、GOS评分、肢体抽搐、意识丧失、偏瘫、失语症，并进行单因素logistic分析。结果：GOS评分(p = 0.003)、肢体抽搐(p = 0.002)、意识丧失(p < 0.001)、偏瘫(p = 0.009)、失语(p = 0.007)与重症颅脑外伤术后行颅骨成形术的时间有显著相关性。病人是否超早期治疗和GOS评分(OR = 10.565, 95% CI: 1.244~89.756, p = 0.031)，四肢痉挛(OR = 0.147, 95% CI: 0.041~0.522, p = 0.003)，意识丧失(OR = 0.770, 95% CI: 0.016~0.380, p = 0.002)，偏瘫(OR = 0.175, 95% CI: 0.016~0.380, p = 0.002)和失语症(OR = 0.189, 95% CI: 0.053~0.670, p = 0.010)有明确的相关性。结论：超早期颅骨修复可改善术后GOS评分、肢体抽搐、意识丧失、偏瘫、失语症。能有效改善神经缺损状态，改善患者的生活能力，改善预后。
Purpose: Craniocerebral injury has a high disability and mortality rate. The choice of the appropriate timing of cranioplasty has a very important impact on the prognosis of patients. Therefore, the paper aims to compare the function prognosis and psychological function status between super early repair and conventional repair. Methods: A total of 60 patients who underwent cranioplasty surgery after severe craniocerebral trauma surgery of a prospective study between January 2017 and January 2020. All patients were divided into two groups according to the time of cranial repair after the operation of craniocerebral injury: super early group (4 - 6 weeks after the operation, 28 cases) and regular group (3 - 6 months after the operation, 32 cases). Sex, age, GOS score, limbs convulsion, loss of consciousness, hemiplegia, and aphasia were recorded. Univariate logistic analysis was performed. Results: GOS score (p = 0.003), limbs convulsion (p = 0.002), Loss of consciousness (p < 0.001), emiplegia (p = 0.009) and aphasia (p = 0.007) were significantly related to the intervention period. And GOS score (OR = 10.565, 95% CI: 1.244 - 89.756, p = 0.031), limbs convulsion (OR = 0.147, 95% CI: 0.041 - 0.522, p = 0.003), Loss of consciousness (OR = 0.770, 95% CI: 0.016 - 0.380, p = 0.002), hemiplegia (OR = 0.175, 95% CI: 0.016 - 0.380, p = 0.002) and aphasia (OR = 0.189, 95% CI: 0.053 - 0.670, p = 0.010) have a clear correlation with whether the patients have super early treatment. Conclusion: Super early cranial repair could improve postoperative GOS score, limbs convulsion, loss of consciousness, hemiplegia, and aphasia. It can also effectively improve the state of nerve defect, and living ability improve prognosis of patients.