重型颅脑损伤后颅骨缺损患者行超早期颅骨修补的安全性临床研究
A Clinical Study on the Safety of Ultra-Early Skull Repair in Patients with Skull Defect after Severe Craniocerebral Injury

目的：颅脑损伤具有较高的死亡率和致残率。去骨瓣减压术在清除血肿的同时可能导致继发性头痛等不良后果。本研究旨在探讨超早期颅骨修补术的安全性和可行性。方法：前瞻性纳入2017年1月至2020年1月在沧州市中心医院治疗的重型颅脑创伤后的颅骨缺损行颅骨修补患者60例。其中超早期组(颅骨缺损后4~6周) 28例，常规组(颅骨缺损后3~6个月) 32例。记录患者的性别、年龄、术后颅内感染、皮下积液、头皮坏死、颅内血肿等并发症的发生情况，并进行单因素logistic分析。结果：单因素Logistic回归提示性别(OR = 6.697, 95% CI: 2.084~21.525, p = 0.001)与患者是否接受超早期治疗有明显的相关性。年龄(OR = 0.433, 95% CI: 0.140~1.340, p = 0.146)、颅内感染(OR = 1.182, 95% CI: 0.333~4.192, p = 0.796)，积液(OR = 1.174, 95% CI: 0.302~4.568, p = 0.817)，头皮坏死(OR = 0.776, 95% CI: 0.216~2.792, p = 0.689)，颅内血肿(OR = 0.776, 95% CI: 0.216~2.792, p = 0.689)与干预时间无明显差异。结论：超早期颅骨修补术可解除患者的可终止或逆转颅骨缺损导致的继发性脑损害，不增加患者术后并发症，具有很好的安全性。
Purpose: Craniocerebral injury has a high mortality and disability rate. Bone flap decompression may lead to secondary headache and other adverse consequences while removing hematoma. The purpose of this study was to investigate the safety and feasibility of ultra-early skull repair. Methods: A total of 60 patients with skull defects after severe craniocerebral trauma treated in Cangzhou Central Hospital from January 2017 to January 2020 were prospectively included. There were 28 cases in the ultra-early group (4 - 6 weeks after skull defect) and 32 cases in the routine group (3 - 6 months after skull defect). The sex, age, postoperative intracranial infection, subcutaneous effusion, scalp necrosis, intracranial hematoma and other complications were recorded, and univariate logistic analysis was performed. Results: Univariate Logistic regression showed that there was a significant correlation between gender (OR = 6.697, 95% CI: 2.084 - 21.525) and whether the patients received ultra-early treatment or not. There was no significant difference in age (OR = 0.433, 95% CI: 0.140 - 1.340, p = 0.146), intracranial infection (OR = 1.182, 95% CI: 0.333 - 4.192, p = 0.796), effusion (OR = 1.174, 95% CI: 0.302 - 4.568, p = 0.817), scalp necrosis (OR = 0.776, 95% CI: 0.216 - 2.792, p = 0.689), intracranial hematoma (OR = 0.776, 95% CI: 0.216 - 2.792, p = 0.689) and intervention time. Conclusion: Ultra-early skull repair can relieve the psychological and mental burden of patients, terminate or reverse the secondary brain damage caused by skull defects, and improve the prognosis of patients.