Efficacy analysis of intracranial hematoma evacuation combined with decompressive craniectomy for traumatic brain injury patients

doi:10.3877/cma.j.issn.2095-9141.2025.03.004

Abstract

Abstract:

Objective

To explore the effect of intracranial hematoma evacuation combined with decompressive craniectomy in the treatment of traumatic brain injury (TBI) patients.

Methods

The clinical data of 94 patients with TBI in Neurosurgery Department of Nanjing Luhe People's Hospital were retrospectively analyzed from January 2020 to January 2024. The patients who underwent intracranial hematoma evacuation and decompressive craniectomy were included in experimental group (49 cases), while those who underwent intracranial hematoma evacuation and bone flap reduction were included in control group (45 cases). The postoperative hematoma clearance rate, intracranial rebleeding rate, and incidence of complications were compared between two groups of patients. The changes in preoperative and postoperative GCS scores, intracranial pressure levels, coagulation function indicators [prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer], serum inflammatory factors [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), procalcitonin (PCT)], and vasoactive factors [vascular endothelial growth factor (VEGF), angiogenin-1 (Ang-1)] were analyzed. The patients were followed up for 3 months, and the prognosis (GOS grading) of two groups of patients was compared.

Results

At 7 d after surgery, the GCS score in both groups was significantly enhanced than that before surgery; While PT and APTT were extended, intracranial pressure, D-dimer, CRP, TNF-α, IL-6, PCT, VEGF and Ang-1 were decreased than before surgery (P<0.05). The GCS score, the hematoma clearance rate, and the intracranial rebleeding rate in experimental group was higher than that in control group while the intracranial pressure, D-dimer, CRP, TNF-α, IL-6, PCT, VEGF and Ang-1 were lower than that in control group (P<0.05). There were no obvious differences in the incidence rates of complications between two groups (P>0.05). After 3 months of follow-up, there was no obvious difference in GOS grading between both groups (P>0.05).

Conclusions

For patients with TBI, intracranial hematoma evacuation combined with decompressive craniectomy can not only effectively removes the hematoma, but also optimize coagulation function, inhibit inflammatory factors, and regulate vascular active factors. Its therapeutic efficacy is superior to that of intracranial hematoma evacuation and bone flap reduction.

Key words: Traumatic brain injury, Intracranial hematoma evacuation, Decompressive craniectomy, Bone flap reduction, Neurological function, Coagulation function

Jiuqiang Fang, Yu Zhai, Junfeng Yang, Bin Shen. Efficacy analysis of intracranial hematoma evacuation combined with decompressive craniectomy for traumatic brain injury patients[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2025, 11(03): 160-166.

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References 23

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组别	例数	年龄（岁，±s）	性别[例（%）]		血肿体积（mL，±s）	致伤原因[例（%）]
组别	例数	年龄（岁，±s）	男	女	血肿体积（mL，±s）	车祸致伤	坠落致伤	砸伤	其他
对照组	45	49.22±5.47	25（55.56）	20（44.44）	51.49±3.87	21（46.67）	10（22.22）	4（8.89）	10（22.22）
试验组	49	49.77±5.06	27（55.1）	22（44.9）	51.60±3.57	25（51.02）	9（18.37）	5（10.20）	10（20.41）
t/χ²值		0.506	0.002		0.143	0.342
P值		0.614	0.965		0.886	0.952

组别	例数	年龄（岁，±s）	性别[例（%）]		血肿体积（mL，±s）	致伤原因[例（%）]
组别	例数	年龄（岁，±s）	男	女	血肿体积（mL，±s）	车祸致伤	坠落致伤	砸伤	其他
对照组	45	49.22±5.47	25（55.56）	20（44.44）	51.49±3.87	21（46.67）	10（22.22）	4（8.89）	10（22.22）
试验组	49	49.77±5.06	27（55.1）	22（44.9）	51.60±3.57	25（51.02）	9（18.37）	5（10.20）	10（20.41）
t/χ²值		0.506	0.002		0.143	0.342
P值		0.614	0.965		0.886	0.952

组别	例数	GCS评分（分，±s）				颅内压（mmHg，±s）				血肿清除率（%，±s）	颅内再出血[例（%）]
组别	例数	术前	术后7 d	t值	P值	术前	术后7 d	t值	P值	血肿清除率（%，±s）	颅内再出血[例（%）]
对照组	45	5.24±2.00	9.08±1.54	10.176	<0.001	45.11±5.00	14.18±3.56	33.804	<0.001	79.21±5.31	4（8.16）
试验组	49	5.27±1.94	10.54±1.21	16.134	<0.001	45.56±4.45	10.18±2.57	48.194	<0.001	83.89±5.52	13（26.53）
t/χ²值		0.074	4.992			0.462	6.283			4.182	4.928
P值		0.941	<0.001			0.645	<0.001			<0.001	0.026

组别	例数	GCS评分（分，±s）				颅内压（mmHg，±s）				血肿清除率（%，±s）	颅内再出血[例（%）]
组别	例数	术前	术后7 d	t值	P值	术前	术后7 d	t值	P值	血肿清除率（%，±s）	颅内再出血[例（%）]
对照组	45	5.24±2.00	9.08±1.54	10.176	<0.001	45.11±5.00	14.18±3.56	33.804	<0.001	79.21±5.31	4（8.16）
试验组	49	5.27±1.94	10.54±1.21	16.134	<0.001	45.56±4.45	10.18±2.57	48.194	<0.001	83.89±5.52	13（26.53）
t/χ²值		0.074	4.992			0.462	6.283			4.182	4.928
P值		0.941	<0.001			0.645	<0.001			<0.001	0.026

组别	例数	颅内感染	脑积水	脑膨出	脑疝	发生率[例（%）]
对照组	45	5	2	6	1	14（31.11）
试验组	49	7	5	2	3	17（34.69）
χ²值						0.136
P值						0.712

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