去骨瓣减压术治疗脑挫裂伤的临床分析

目的分析去骨瓣减压术治疗脑挫裂伤的短期及跃期疗效，并进一步分析不同大小骨窗的疗效差别.方法对100例脑挫裂伤患者进行去骨瓣减压术治疗，观察手术前后颅内压变化及头颅CT中线移位和基底池形态改变以判定减压术的短期效果：分析3月后GOS预后评分以判定减压术的艮期效果；按骨窗范围大小分为大骨瓣组和中等骨瓣组，分析两组的疗效差异。结果脑挫裂伤患者进行去骨瓣减压术后，能有效的降低颅内压在270mmH2O以下，P〈0．05；术后第1、3、7天颅内压与术前颅内压相比，均有明显下降，P〈0．05；手术后颅脑CT显示的中线移位程度与基底池形态较术前CT均有明显改善，P〈0．05。大骨瓣组第1、3天颅内压较中等骨瓣组为低．P〈0．05；但第7天颅内压两组无明显差异（P〉0.05）；患者伤后3月随访结果：恢复良好52例（52．0％）、轻残16例（16．0％）、重残12例（12．0％）、植物生存4例（4．0％）、死亡16例（16．O％），而且统计分析得出大骨瓣组预后优于中等骨瓣组，P〈0．05；大、中等骨瓣组的常见手术并发症切口脑脊液漏、外伤性癫痫、颅内感染、外伤性脑积水均无明显差异，P〉0．05。结论脑挫裂伤患者进行去骨瓣减压术能有效地降低颅内压及改善CT影像学征象，能明显降低死亡率和重残率．从而改善脑挫裂伤患者的短期及长期疗效：早期进行大骨瓣减压术的疗效优于中等骨瓣减压组．

The Clinical Effect of Decompressed Craniectomy for Brain Injury

Objective A prospective investigation for discussing the short and the long term effects of decompressed craniectomy(DC) in the treatment of brain injury and for discussing the differential effects between the large bone flaps and the moderate bone flaps.Methods 100 cases with brain injury were managed with DC and we observed the alteration of intracranial pressure (ICP),middle line structure shift and basal cistern of CT images.We also analysed all the patients' Glasgow outcome scores (GOS) of 3 months after DC.All cases were divided into the large and the moderate bone flap groups according to area of DC and we analysed the effects between the two groups.Results ICP decreased significantly below 270mmH_2O after DC in all traumatic brain injury cases,P<0.05;the shift of middle line structure and basal cistern of CT images were improved,P<0.05.ICP in large flap group was lower than moderate flap group in 1,3 days after DC,P<0.05.But ICP has no difference between the two groups in 7 days after DC,P>0.05.After GOS of 3 months follow-up,52 cases got good recovery (52.0%),16 cases moderate deficit (16.0%), 12 cases severe deficite (12.0%),4 cases of vegetative status (4.0%) and 16 cases died (16.0%),and large flap DC has better prognosis than moderate flap DC,P<0.05.There was no difference between the large and moderate flap groups about some common complications,P>0.05. Conclusion DC can significantly decrease ICP,improve the signs of CT image and can get good short and long-term effects.Early large flap DC has better clinical effects than moderate flap DC.