Effect of stepped decompression and control of bone flap on prognosis of patients with severe traumatic brain injury

doi:10.3877/cma.j.issn.2095-9141.2019.01.007

Abstract

Abstract:

Objective

To analyze the effect of stepped decompression and control of bone flap on prognosis of patients with severe traumatic brain injury.

Methods

Eighty-four patients with severe traumatic brain injury admitted to the Department of Neurosurgery, Huangmei People’s Hospital from November 2014 to November 2016 were selected as the study subjects. They were divided into experimental group (42 cases) and control group (42 cases) according to random number table method. The experimental group was treated with stepped decompression of bone flaps, while the control group was treated with conventional craniotomy. Intracranial pressure (ICP) was compared before operation, 1, 3 and 7 d after operation in two groups. Complications were observed in two groups. National Institutes of Health Stroke Scale (NIHSS) was compared 1 month after operation in two groups.

Results

The ICP of the experimental group was lower than that of the control group on the 1^st, 3^rd and 7^th day after operation (P<0.05). The incidence of complications in the experimental group was significantly lower than that in the control group (P<0.05). The NIHSS score of the two groups decreased 1 month after operation, and the NIHSS score of the experimental group was lower than that of the control group, the difference was statistically significant (P<0.05). The therapeutic effect of the experimental group was significantly higher than that of the control group (P<0.05).

Conclusion

Compared with conventional craniotomy, stepped decompression and control of bone flap can accelerate the recovery of nerve function and reduce the occurrence of complications in patients with severe traumatic brain injury, and has good curative effect.

Key words: Controlled step decompression, Severe traumatic brain injury, Neurological function, Intracranial pressure

Bin Wang, Jin Mei. Effect of stepped decompression and control of bone flap on prognosis of patients with severe traumatic brain injury[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2019, 05(01): 29-32.

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References 16

[1]	AI-Jehani H, Petrecca K, Martel P, et al. Decompressive craniectomy for ischemic stroke: effect of hemorrhagic transformation on outcome[J]. J Stroke Cerebrovasc Dis, 2016, 25(9):2177-2183.
[2]	李建军，徐文中，丁健,等.去骨瓣减压术对对冲性颅脑外伤颅内压和预后影响的Meta分析[J].中华神经外科疾病研究杂志, 2018, 17(2):155-158.
[3]	Su CH, Liu JT, Chang CS, et al. Delayed contralateral epidural hematoma after decompressive craniectomy for a traumatic acute subdural hematoma[J]. Formos J Surg, 2015, 48(6):222-225.
[4]	Waqas M, Bakhshi SK, Shamim MS, et al. Radiological prognostication in patients with head trauma requiring decompressive craniectomy: analysis of optic nerve sheath diameter and rotterdam CT scoring system[J]. J Neuroradiol, 2016, 43(1):25-30.
[5]	Yang CH, Li Q, Wu C, et al. Decompressive craniectomy or not: intraoperative experience in 41 patients with severe traumatic brain injury[J]. Chin J Traumatol, 2012, 15(3):158-161.
[6]	Wan Y, Fei X, Shi L, et al. Methods of intra-operative treatment of cranioplasty in patients with abnormal bone window flap pressure after decompressive craniectomy[J]. Clin Neurol Neurosurg, 2016, 14(2):1537-1542.
[7]	Nasi D, Dobran M, Iacoangeli M, et al. Paradoxical brain herniation after decompressive craniectomy provoked by drainage of subdural hygroma[J]. World Neurosurg, 2016, 91:673.e1-e4.
[8]	Missori P, Marruzzo D, Paolini S, et al. Autologous skull bone flap sterilization after decompressive craniectomy: an update[J]. World Neurosurg, 2016, 90:478-483.
[9]	Honeybul S, Ho KM. Predicting long-term neurological outcomes after severe traumatic brain injury requiring decompressive craniectomy: a comparison of the CRASH and IMPACT prognostic models[J]. Injury, 2016, 47(9):1886-1892.
[10]	Borger V, Schuss P, Kinfe TM, et al. Decompressive craniectomy for stroke: early cranioplasty is a predictor for postoperative complications[J]. World Neurosurg, 2016, 92:83-88.
[11]	李震亮，姚冬梅，幺桂兰.去骨瓣减压术联合颞肌贴敷对脑梗死患者血清相关炎性因子及免疫功能的影响[J].中国临床研究, 2016, 29(6):788-790, 793.
[12]	Kinoshita T, Yoshiya K, Fujimoto Y, et al. Decompressive craniectomy in conjunction with evacuation of intracranial hemorrhagic lesions is associated with worse outcomes in elderly patients with traumatic brain injury: a propensity score analysis[J]. World Neurosurg, 2016, 89:187-192.
[13]	Miller K, Eljamel S. Does size and site matter in therapeutic decompressive craniectomy? A laboratory-based experimental study[J]. World Neurosurg, 2016, 95:441-446.
[14]	Lammy S, Al-Romhain B, Osborne L, et al. 10-year institutional retrospective case series of decompressive craniectomy for malignant middle cerebral artery infarction(mMCAI)[J]. World Neurosurg, 2016, 96:383-389.
[15]	Jabbarli R, Oppong MD, Dammann P, et al. Time is brain! Analysis of 245 cases with decompressive craniectomy due to subarachnoid hemorrhage[J]. World Neurosurg, 2017, 98:689-694.e2
[16]	Weickenmeier J, Butler CAM, Young PG, et al. The mechanics of decompressive craniectomy: Personalized simulations[J]. Comput Methods Appl Mech Engrg, 2017, (314):180-195.

组别	例数	术前	术后1 d	术后3 d	术后7 d
试验组	42	34.83±5.74	21.93±2.34	17.91±1.60	13.79±1.99
对照组	42	34.68±5.67	27.87±2.92	25.13±1.59	20.23±2.14
t值	?	0.120	10.288	11.365	11.636
P值	?	0.905	0.001	0.001	0.001

组别	例数	术前	术后1 d	术后3 d	术后7 d
试验组	42	34.83±5.74	21.93±2.34	17.91±1.60	13.79±1.99
对照组	42	34.68±5.67	27.87±2.92	25.13±1.59	20.23±2.14
t值	?	0.120	10.288	11.365	11.636
P值	?	0.905	0.001	0.001	0.001

组别	例数	硬膜下积液	迟发性颅内水肿	脑积水	颅内感染	急性脑膨出	外伤性癫痫	切口脑脊液漏	大面积脑梗死	发生率
对照组	42	3（7.14）	5（11.90）	5（11.90）	3（7.14）	6（14.29）	3（7.14）	2（4.76）	1（2.38）	28（66.67）
试验组	42	2（4.76）	3（7.14）	1（2.38）	2（4.76）	3（7.14）	2（4.76）	1（2.38）	3（7.14）	17（40.48）
χ²值	?	?	?	?	?	?	?	?	?	4.620
P值	?	?	?	?	?	?	?	?	?	0.032

组别	例数	硬膜下积液	迟发性颅内水肿	脑积水	颅内感染	急性脑膨出	外伤性癫痫	切口脑脊液漏	大面积脑梗死	发生率
对照组	42	3（7.14）	5（11.90）	5（11.90）	3（7.14）	6（14.29）	3（7.14）	2（4.76）	1（2.38）	28（66.67）
试验组	42	2（4.76）	3（7.14）	1（2.38）	2（4.76）	3（7.14）	2（4.76）	1（2.38）	3（7.14）	17（40.48）
χ²值	?	?	?	?	?	?	?	?	?	4.620
P值	?	?	?	?	?	?	?	?	?	0.032

组别	例数	术前	术后1个月
试验组	42	44.69±6.51	14.01±3.57
对照组	42	45.03±6.23	22.34±3.09
t值	?	1.265	11.434
P值	?	0.185	0.001

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