标准大骨瓣减压术在重型颅脑损伤导致的晚期脑疝双瞳孔散大治疗中的临床效果

目的标准大骨瓣减压术在重型颅脑损伤（sTBI）导致的晚期脑疝双瞳孔散大治疗中的临床效果。 方法选取爱德堡医院神经外科自2014年7月至2017年7月收治的sTBI致晚期脑疝双瞳孔散大的患者70例，采取随机数字表法分为对照组和观察组，每组35例。对照组行常规骨瓣开颅术，观察组行标准大骨瓣开颅术治疗，对比2组近期疗效及术后并发症发生情况。 结果观察组术后1个月恢复良好率（31.43%）明显高于对照组（8.57%），重残占比（11.43%）明显低于对照组（34.29%），差异具有统计学意义（P<0.05）。2组轻残率、植物生存率、死亡率的差异均无统计学意义（P>0.05）。观察组术后并发症发生率（34.29%）低于对照组（77.14%），差异具有统计学意义（P<0.05）。 结论标准大骨瓣开颅术应用于sTBI所致的晚期脑疝双瞳孔散大可获得显著效果，能有效减少患者术后并发症，值得临床推广。

Clinical study of standard large bone flap craniotomy for treatment of double cerebral mydriasis due to severe traumatic brain injury

ObjectiveTo investigate the clinical effect of standard large bone flap craniotomy for the treatment of double cerebral mydriasis in patients with severe traumatic brain injury (sTBI). MethodsSeventy patients with bilateral mydriasis of sTBI induced terminal hernia admitted from July 2014 to July 2017 in our hospital were randomly divided into two groups. The control group (35 cases) underwent conventional craniotomy, and the observation group (35 cases) underwent standard craniotomy. Compare the two groups of short-term efficacy and postoperative complications. ResultsThe recovery rate in observation group was 31.43% at one month after operation, which was significantly higher than that in control group (8.57%, P<0.05). The proportion of severe disability was 11.43%, also significantly lower than the control group (34.29%, P<0.05). There was no significant difference in the proportions of light residue, plant survival and death between the two groups (P>0.05). The incidence of postoperative complications in the observation group was 34.29%, which was significantly lower than that in the control group (77.14%, P<0.01). ConclusionThe application of standard large bone flap craniotomy in sTBI induced bilateral mydriasis may lead to significant results, which can effectively reduce postoperative complications and is worthy of clinical promotion.