小脑幕裂孔切开联合大骨瓣减压术治疗小脑幕切迹疝的临床研究

目的研究小脑幕切开联合大骨瓣减压治疗小脑幕切迹疝的疗效与应用价值。方法60例脑外伤或脑出血导致的小脑幕切迹疝病人随机分为小脑幕裂孔切开组（行大骨瓣减压术同时切开小脑幕裂孔）和非小脑幕裂孔切开组（仅行大骨瓣减压术），每组30例。术后48h复查CT，对比组间脑干周围池改善率。对比组间应激性溃疡发生率、病死率、术后2周与4周的GCS评分，及术后26周的GOS评分。结果术后48h头颅CT显示脑干周围池改善率小脑幕裂孔切开组显著高于非小脑幕裂孔切开组。小脑幕裂孔切开组病死率、应激性溃疡发生率低于非小脑幕裂孔切开组。GCS评分术后2周时小脑幕裂孔切开组显著高于非小脑幕裂孔切开组，术后4周时小脑幕裂孔切开组显著高于非小脑幕裂孔切开组。术后26周的GOS评分小脑幕裂孔切开组高于非小脑幕裂孔切开组。结论小脑幕裂孔切开联合大骨瓣减压治疗小脑幕切迹疝优于单纯大骨瓣减压，显著降低病死率，改善预后。

Clinical research of openinog of the tentorial hiatus combined with decompressive cramiectomy for treatina trausltentorial herniation

Objective To investigate the therapeutic effect and applied value of tentorial splitting （opening the tentorial hiatus） combined with decompressive craniectomy on transtentorial herniation. Methods Sixty patients with transtentorial herniation induced by brain injury or intracranial hemorrhage were equally divided into 2 groups： tentorial splitting group （patients were treated by decompressive craniectomy and tentorial splitting） and non tentorial splitting group （only treated by decompressive craniectomy）, 30 cases for each group. The improvement of narrow tentorial cisterns was investigated at 48 h after the procedures by CT. Incidence of stress ulcer and mortality were investigated in the two groups. Glasgow coma scale scores were compared between 2 groups at 2 and 4 weeks after surgical treatment. Glasgow outcome scale scores were investigated at 26 weeks postoperatively. Results The improvement of narrow tentorial cisterns was better in tentorial splitting group than non tentorial splitting group. The mortality and incidence of stress ulcer was lower in tentorial splitting group than in non tentofial splitting group. Glasgow coma scale score in tentorial splitting group was slightly higher than that in non tentorial splitting group at 2 weeks postoperatively, while significantly higher than that in non tentorial splitting group at 4 weeks postoperatively. Glasgow outcome score in tentorial splitting group was superior to that in non tentorial splitting group at 26 weeks after the operation. Conclusion Combination of tentorial splitting and decompressive craniectomy is superior to decompressive craniectomy alone in treating trans-tentorial herniation and can significantly reduce mortality and improve prognosis of the patients.