改良外伤大骨瓣开颅减压术治疗特重型颅脑对冲伤临床研究(1)
[摘要] 目的 研究特重型颅脑对冲伤患者采用改良外伤大骨瓣开颅减压术治疗的临床效果。方法 方便选取86例该院2013年9月—2015年9月期间收治的特重型颅脑对冲伤患者作为研究对象。按手术方式不同分为两组，其中43例患者采用标准大骨瓣开颅减压术治疗作为对照组，另43例患者采用改良外伤大骨瓣开颅减压术治疗作为观察组。观察两组患者治疗后颅内压情况、预后情况以及并发症情况。结果 两组术前颅内压水平差异无统计学意义(P>0.05)；观察组术后1、3 d颅内压水平明显低于对照组(P<0.05)。观察组预后情况明显优于对照组(P<0.05)。观察组、对照组并发症发生率分别为9.30%、27.91%，观察组明显较低(P<0.05)。结论 对于特重型颅脑对冲伤患者采用改良外伤大骨瓣开颅减压术治疗效果显著，有效降低了颅内压水平，改善患者预后情况，并发症少，安全性高，值得临床推广应用。
[关键词] 颅脑对冲伤；大骨瓣开颅减压术；改良外伤大骨瓣开颅减压术；临床疗效
[中图分类号] R6 [文献标识码] A [文章编号] 1674-0742(2017)05(a)-0080-03
[Abstract] Objective To study the adoption of Modified Trauma Large Bone Craniotomy Decompression in the treatment of patients with severe cerebral hedge injury. Methods 86 cases of patients with severe cerebral hedge injury admitted to our hospital from September 2013 to September 2015 were convenient selectiond as the research object. The patients were divided into two groups according to different surgical procedures. 43 cases of patients were treated with standard large bone craniotomy decompression and served as the control group， and the other 43 patients were treated with modified large trauma large bone craniotomy and served as the observation group to observe intracranial pressure， prognosis and complications of the patients in two groups. Results There was no difference between the two groups in preoperative intracranial pressure with(P>0.05)； after 1d and 3d of the operation， the levels of intracranial pressure in the observation group were significantly lower than that of the control group with(P<0.05). The prognosis of the observation group was significantly better than that of the control group with(P<0.05). The incidence of complications in the observation group and the control group were 9.30% and 27.91% respectively. The observation group was significantly lower with(P<0.05). Conclusion The adoption of modified trauma large bone craniotomy decompression has significant therapeutic effect， effectively low the intracranial pressure level， and improve patients’ prognosis with few complications and higher safety on patients with severe cerebral hedge injury so that it’s worthy of popularization and application.
[Key words] Craniocerebral Injury； Large Bone Craniotomy Decompression ； Modified Trauma Large Bone Craniotomy Decompression； Clinical Efficacy
重型颅脑对冲伤是颅脑外伤最严重的一种，常伴有严重脑挫裂伤及硬膜下血肿，致死致残率极高，引起人们的关注和重视。彻底清除颅内血肿以及坏死脑组织是临床治疗原则，有效降低颅内压是手术治疗的关键。既往临床采用大骨瓣开颅减压术治疗，可有效降低顱内压，通过骨窗进行血肿和坏死脑组织清除。但受到骨窗大小的限制，难以彻底清除病灶及血肿，术后容易发生脑水肿、脑疝等并发症，治疗效果不够理想。随着手术技巧的不断提高，目前研究发现[1]，改良外伤大骨瓣开颅减压术相对于传统大骨瓣开颅减压术具有更好的手术视野，但疗效需要临床进一步研究。因此该文对2013年9月—2015年9月期间该院收治的86例特重型颅脑对冲伤患者进行手术治疗，探讨改良外伤大骨瓣开颅减压术对患者的临床疗效，现报道如下。, http://www.100md.com(龚明 廖昆 刘金辉 樊静 黎开谷)
[关键词] 颅脑对冲伤；大骨瓣开颅减压术；改良外伤大骨瓣开颅减压术；临床疗效
[中图分类号] R6 [文献标识码] A [文章编号] 1674-0742(2017)05(a)-0080-03
[Abstract] Objective To study the adoption of Modified Trauma Large Bone Craniotomy Decompression in the treatment of patients with severe cerebral hedge injury. Methods 86 cases of patients with severe cerebral hedge injury admitted to our hospital from September 2013 to September 2015 were convenient selectiond as the research object. The patients were divided into two groups according to different surgical procedures. 43 cases of patients were treated with standard large bone craniotomy decompression and served as the control group， and the other 43 patients were treated with modified large trauma large bone craniotomy and served as the observation group to observe intracranial pressure， prognosis and complications of the patients in two groups. Results There was no difference between the two groups in preoperative intracranial pressure with(P>0.05)； after 1d and 3d of the operation， the levels of intracranial pressure in the observation group were significantly lower than that of the control group with(P<0.05). The prognosis of the observation group was significantly better than that of the control group with(P<0.05). The incidence of complications in the observation group and the control group were 9.30% and 27.91% respectively. The observation group was significantly lower with(P<0.05). Conclusion The adoption of modified trauma large bone craniotomy decompression has significant therapeutic effect， effectively low the intracranial pressure level， and improve patients’ prognosis with few complications and higher safety on patients with severe cerebral hedge injury so that it’s worthy of popularization and application.
[Key words] Craniocerebral Injury； Large Bone Craniotomy Decompression ； Modified Trauma Large Bone Craniotomy Decompression； Clinical Efficacy
重型颅脑对冲伤是颅脑外伤最严重的一种，常伴有严重脑挫裂伤及硬膜下血肿，致死致残率极高，引起人们的关注和重视。彻底清除颅内血肿以及坏死脑组织是临床治疗原则，有效降低颅内压是手术治疗的关键。既往临床采用大骨瓣开颅减压术治疗，可有效降低顱内压，通过骨窗进行血肿和坏死脑组织清除。但受到骨窗大小的限制，难以彻底清除病灶及血肿，术后容易发生脑水肿、脑疝等并发症，治疗效果不够理想。随着手术技巧的不断提高，目前研究发现[1]，改良外伤大骨瓣开颅减压术相对于传统大骨瓣开颅减压术具有更好的手术视野，但疗效需要临床进一步研究。因此该文对2013年9月—2015年9月期间该院收治的86例特重型颅脑对冲伤患者进行手术治疗，探讨改良外伤大骨瓣开颅减压术对患者的临床疗效，现报道如下。, http://www.100md.com(龚明 廖昆 刘金辉 樊静 黎开谷)