Comparison Of The Clinical Effects Of Different Periods Of Cranioplasty After Decompressive Craniectomy For Trauma

Objective To observe the effect of different operation time operation of skull defect cranioplasty in patients with postoperative neurological function recovery, the situation(including average operation time,average free flap time and average intraoperative bleeding) in operation and complications, and investigate the best time of patients with craniocerebral trauma skull defect cranioplasty after decompressive craniectomy operation.Methods: Seventy-two cases of decompressive craniectomy postoperative patients in our hospital from December 2012 to October 2014 were selected. According to the repairing time, these patients were divided into three groups: early stage group(between 4 to 8 weeks after decompressive craniectomy operation), middle stage group(between 9 to 12 weeks after decompressive craniectomy operation) and advanced stage group(after 13 weeks after decompressive craniectomy operation).Compared the three groups of patients with postoperative nerve function recovery the situation in operation and complications. Analyze the clinical data of the three groups with statistic methods.Results:1. It was easy to make free skin flap in the early stage group with the average operation time of 95.89±5.23 min and average free flap time of 21.39±5.04 min, average intraoperative bleeding of 352.50±41.68ml; In the middle stage group, the average operation time was 101.90±7.08 min, the average time of free flap was 24.47±4.77 min, average intraoperative bleeding was 385.17±55.60ml; In the advanced stage group, the average operation time was 107.75±15.04 min, the average time of free flap was 27.33±5.40 min, average intraoperative blood loss of 417.63±54.42 ml. Significant difference between the three groups of the patients were observed(P<0.05).The index of early stage group and middle stage group were significantly lower than those in the advanced stage group, and the index of early stage group were significantly lower than middle stage group, with statistical difference(P<0.05).2. The complications rate of early stage group was 16.67%, with wound infection in 0 case, subcutaneous effusion in 2 cases and subdural hematoma in 1 case; the complications rate of middle stage group was 10%, with wound infection in 1 case, subcutaneous effusion in 1 case and subdural hematoma in 1 case; the complications rate of advanced stage group was 16.67%,with wound infection in 2 cases, subcutaneous effusion in 1 case and subdural hematoma in 1 case. The differences of complications among the three groups was not statistically significant(P>0.05).3. GCS,GOS and KPS scores of early stage group and middle stage group were significantly lower than those in the advanced stage group( P<0.05). Between early stage group and middle stage group, the GCS,GOS and KPS scores were not statistically significant(P>0.05); the GCS,GOS and KPS scores of advanced stage group was significantly lower than those in early stage group and middle stage group, with significant difference( P<0.05).Conclusions:In the absence of significant operation contraindications, cranioplasty for skull defect operation as soon as possible, more conducive to the recovery of neurological function, decrease the time for free flap, operation and intraoperative blood loss,worthy to be widely applied in clinic.