重型自发性脑出血患者去骨瓣减压术中骨瓣还纳决策的影响因素

doi:10.3969/j.issn.1671-7171.2026.03.027

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Abstract 【Objective】 To explore the clinical factors influencing the decision of bone flap replantation during decompressive craniectomy in patients with severe spontaneous intracerebral hemorrhage. 【Methods】 The clinical data of 64 patients with severe spontaneous intracerebral hemorrhage admitted to our hospital from February 2022 to February 2025 were retrospectively analyzed. According to whether the bone flap was replanted during the operation, the patients were divided into the replantation group (n=30) and the non-replantation group (n=34). The baseline data and clinical characteristics of the two groups were compared. Univariate and multivariate Logistic regression were used to screen the clinical factors related to the bone flap replantation decision, and the short-term good prognosis rate of the two groups was compared. According to the Glasgow Outcome Scale (GOS) score 3 months after operation, the patients in the replantation group were further divided into the good prognosis group (n=18) and the poor prognosis group (n=12), and the related factors affecting the prognosis of the patients with bone flap replantation were analyzed. 【Results】 The age of patients in the replantation group and the incidence of acute intraoperative cerebral herniation, hematoma rupture into the ventricle and midline shift were lower than those in the non-replantation group, with statistically significant differences (P<0.05). Multivariate Logistic regression analysis showed that age, hematoma rupture into the ventricle, acute intraoperative cerebral herniation and midline shift were the influencing factors for bone flap replantation in patients with severe spontaneous intracerebral hemorrhage (all P<0.05). After 3 months of follow-up, 18 patients (60.00%) in the replantation group had a good prognosis, and 12 patients (35.29%) in the non-replantation group had a good prognosis. The good prognosis rate of the replantation group was higher than that of the non-replantation group (χ²=3.906, P=0.048). Among the patients with bone flap replantation, the age, incidence of midline shift, postoperative hydrocephalus and severe cerebral edema 2 weeks after operation in the poor prognosis group were higher than those in the good prognosis group, and the GCS score 1 week after operation was lower than that in the poor prognosis group, with statistically significant differences (P<0.05). 【Conclusion】 Age, hematoma rupture into the ventricle, acute intraoperative cerebral herniation and midline shift are the key clinical factors affecting the decision of bone flap replantation during decompressive craniectomy in patients with severe spontaneous intracerebral hemorrhage. For patients with replantation conditions, those who receive primary replantation have a significantly higher short-term good prognosis rate. However, among patients with bone flap replantation, advanced age, preoperative midline shift, postoperative hydrocephalus, severe cerebral edema and poor early neurological status are still important indicators of poor short-term prognosis.

Key words： Cerebral Hemorrhage Decompressive Craniectomy

Received: 12 December 2025

PACS:

R743.34

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	ZHANG Cheng
	LI Jinhui

Cite this article:

ZHANG Cheng,LI Jinhui. Influencing Factors of Bone Flap Replantation Decision in Decompressive Craniectomy for Patients with Severe Spontaneous Intracerebral Hemorrhage[J]. JOURNAL OF CLINICAL RESEARCH, 2026, 43(3): 449-452.

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http://journal07.magtech.org.cn/yxlcyj/EN/10.3969/j.issn.1671-7171.2026.03.027 OR http://journal07.magtech.org.cn/yxlcyj/EN/Y2026/V43/I3/449

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