目的 评价颅脑损伤术后颅骨缺损患者超早期行颞肌下颅骨成形术的临床疗效.方法 2007年1月-2011年9月在我院行颅骨成形术且术前存在神经功能障碍患者105例,根据修补术与减压术之间的间隔时间分为超早期组59例和晚期组46例.两组修补术与减压术之间的间隔时间,超早期组平均(35.1±5.3)d;晚期组平均(102.3±18.2)d.回顾性分析两组修补术后1个月的神经功能障碍改善情况,以此评价超早期颅骨成形术的临床疗效. 结果 术后1个月超早期组神经功能障碍改善的平均有效率为81.4％(48/59),高于晚期组的63.0％( 29/46),差异显著(P＜0.05).术后一个月超早期组遗留的神经功能障碍包括单侧肢体(含单纯上肢或下肢)运动障碍25例,语言功能障碍14例,神经官能症5例,颅骨缺损综合征33例;晚期组则包括单侧肢体运动障碍5例,语言功能障碍7例,神经官能症2例,颅骨缺损综合征27例. 结论 超早期颅骨成形术有助于改善颅脑损伤术后颅骨缺损患者的神经功能障碍.%Objective To evaluate the clinical effects of subtemporal cranioplasty in ultra early stage for patients with skull defect after depression surgery due to craniocerebral injury. Methods There were 105 skull defect cases with various degrees of neurological dysfunction reeieved cranioplasty. According to the duration between the decompression procedure and the cranioplasty, these 105 patients were divided into two groups, the ultra early group (n =59) and the advanced group (n =46) . Their neurological function improvement one month after cranioplasty was retrospectively analyzed. Average surgical interval between the decompression and the cranioplasty was(35.1 ?. 3) days in ultra early group, and( 102. 3 ?18. 2) days of the advanced group. Results One month after the cranioplastic surgery, the effective rate of ultra early group was 81.4% (48/59) in terms of neurological function improvement, which was better than that of late group, 63.0% (29/46) (P <0. 05). But in these improved patients, there were still neurological dysfunctions , including the single limb (including pure upper limb or lower limb) dyscinesia in 25 cases, the linguistic dysfunction in 14 cases, the neurosis 5 cases and the skull defect syndrome in 33 cases in the ultra early group. And in the advanced group there were single limb dyscinesia in 5 cases, linguistic dysfunction in 7 cases, neurosis in 2 cases and skull defect syndrome in 27 cases. Conclusion Cranioplasty at ultra early stage may be helpful to improve the neurological function in patients with skull defect.
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