标准大骨瓣开颅减压术治疗重型颅脑损伤的疗效观察
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[摘要] 目的：探讨标准大骨瓣开颅减压术治疗重型颅脑损伤的手术方式及临床效果。方法：将79例重型颅脑损伤患者随机分为两组，观察组40例采用标准大骨瓣开颅减压术，对照组39例采用常规骨瓣开颅术。观察两组术后恢复情况并进行对比分析。结果：观察组患者术后恢复情况明显优于对照组(P<0.05)，而中残率和长期昏迷则低于对照组(P<0.05)；两组并发症发生率分别为37.50%、66.67%，差异有统计学意义(P<0.05)。结论：标准大骨瓣开颅减压术治疗重型颅脑损伤具有操作简便、减压彻底等优点，可明显改善预后，减少后遗症，提高患者的生存质量。
[关键词] 重型颅脑损伤；标准大骨瓣开颅减压术；常规骨瓣开颅术；疗效观察
[中图分类号] R651.1+5 [文献标识码]A[文章编号]1674-4721(2011)07(a)-024-03
The observation of curative effect on the standard large trauma craniotomy in severe craniocerebral injury
HUANG Weihao
Deparment of Military Sursery,the People′s Hospital of Taishan City, Guangdong Province, Taishan 529200, China
[Abstract] Objective: To evaluate the modus operandi and clinical effect of the standard large trauma craniotomy in severe craniocerebral injury. Methods: 79 severe craniocerebral injury patients were randomly divided into two groups, 40 cases in the observation group were adopted the standard large trauma craniotomy, 39 cases in the control group were adopted the old craniotomy with bone flap. To observe the comeback circs after surgery and comparative analyzed in two groups. Results: The comeback circs after surgery of the observation group was better than the control group (P<0.05), the moderate disabled rate and long-term coma were lower than the control group (P<0.05). The complication incidence rate in two groups were 37.50% and 66.67%, there were difference statistical significance between them (P<0.05). Conclusion: The standard large trauma craniotomy treatment for severe craniocerebral injury, its strongpoint is easy and simple to handle, reducing pressure in grain and so on, it can be ameliorate prognosis, abate the sequela, improve the patient′s quality life.
[Key words] Severe craniocerebral injury; Standard large trauma craniotomy; Old craniotomy with bone flap; Efficacy
伴随着我国经济迅速发展，现代工业和道路建设的突飞猛进，颅脑创伤患者呈明显增加趋势， 重型颅脑损伤是一种常见的神经外科疾病，病死率一直保持在30%~50%[1]，是救治的重点难点，开颅手术是救治的关键。而如何降低重型颅脑损伤患者的高病死率和致残率一直是困扰着神经外科专家及学者的难题。近年来国内外普遍推广采用的标准外伤大骨瓣减压术能够显著降低重型颅脑损伤患者的死残率[2]。本院采用标准大骨瓣开颅减压术治疗重型颅脑损伤患者40例，获得满意效果，现总结分析报道如下：
1 资料与方法
1.1 一般资料
本组79例患者均为本院2006年1月~2010年8月收治的重型颅脑损伤患者，均昏迷，生命体征有不同程度改变，入院时格拉斯哥昏迷评分(glasgow coma score，GCS)：6～8分者43例，3～5分者36例。致伤原因：交通伤48例，高处坠落伤25例，砸伤或打击伤6例。受伤机制：加速伤22例，减速伤53例，机制不明确4例。着力部位：枕部着力32例，额部20例，颞部17例，顶部10例。所有患者入院即行头颅CT，损伤类型包括：广泛脑挫裂伤 ......
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