两种不同术式治疗重型颅脑损伤合并脑肿胀的临床疗效分析(1)
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【摘要】 目的 探讨标准大骨瓣减压术及额颞去骨瓣加内减压术治疗重型颅脑损伤合并脑肿胀的不同疗效。方法 回顾分析56例重型颅脑损伤合并脑肿胀患者的手术资料,按采取的不同手术方式随机分为两组,分别比较两组术后的并发症发生率、近、远期疗效等。结果 两组患者早期并发症发生率及术后一周GOS评分差异有显著性(P<0.05)。近期疗效及晚期并发症发生率比较差异有显著性(P<0.05)。晚期疗效比较差异无显著性(P>0.05)。结论 额颞去骨瓣加内减压术具有损伤小、减压充分、并发症发生率低等特点,能降低死亡率和致残率,提高重型颅脑损伤合并脑肿胀患者的近期疗效,促进恢复。
【关键词】标准大骨瓣减压术;内减压手术;颅脑损伤;脑肿胀
The clinical analysis of two different surgical treatment on severe head injury with brain swelling
LIU Yong-sheng,SONG Lai-jun.Department of Neurosurgery,the First People’s Hospital of Shangqiu city,Henan 476005,China
【Abstract】 Objective To study the different effects of standard large trauma craniotomy and frontotemporal craniectomy and decompression treatment to cure severe head injury with brain swelling.Methods Retrospective analysis of 56 cases of severe head injury with brain swelling in patients with operation data,They were divided into two groups according to the different operation methods,and compared the incidence of postoperative complications,and short-term effect,long-term effect and so on.Results The difference was significant in two groups of patients of incidence of early complications and postoperative GOS score a week(P<0.05).There was a significant difference in close effect and late complication rate(P<0.05).There was no significant differences in late effect(P>0.05).Conclusion Frontotemporal craniotomy and decompression surgery have features such as a little injury,decompression full,low complication rate,and can improve the short-term efficacy of severe head injury with brain swelling in patients,and promote the patients’recovery.
【Key words】Standard large trauma craniotomy;Decompression surgery;Traumatic brain injury;Brain swelling
重型颅脑损伤在临床工作中十分常见,多因合并颅内脑挫裂伤、脑内血肿、广泛颅骨骨折和脑水肿等而导致较高的死亡率和致残率,多数情况下需要立即开颅手术减压,以挽救患者生命。但对重型颅脑损伤头颅CT主要表现为弥漫性脑肿胀的患者,人们对其是否需要手术减压以及采取哪种手术方式减压等问题到目前还有争议。我科自2007年5月至2010年1月分别采用标准大骨瓣减压术和额颞去骨瓣加内减压术两种方法治疗重型颅脑损伤合并脑肿胀患者56例,本文比较评价各自手术效果,报告如下。
1 资料与方法
1.1 一般资料 本组共56例,男44例,女12例;年龄15~85岁,平均38.6岁,其中以20~40岁年龄组最多。既往有高血压病史者9例,糖尿病病史者5例。单纯头颅外伤(含颅底骨折)者40例,合并其他脏器及肢体损伤者16例,包括面部外伤、肢体骨折、肋骨骨折及肺部挫伤、锁骨骨折、骨盆骨折及脏器损伤(肝脏、脾脏及肾脏挫伤、挫裂伤)等。
1.2 临床表现 入院时大多数患者神志不清,GCS评分:3~5分14例,6~8分35例,9分及以上7例。肢体强直37例,瞳孔不等大34例,一侧肢体瘫痪45例 ......
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