双侧标准外伤大骨瓣减压术治疗特重型颅脑损伤临床分析

目的探讨双侧标准外伤大骨瓣减压术在治疗特重型颅脑损伤中的作用。方法 2006年1月至2011年12月收治的130例特重型颅脑损伤施行标准外伤大骨瓣减压手术患者的临床资料进行回顾性分析,其中2006年1月至2008年12月仅行单纯病灶侧标准外伤大骨瓣减压手术64例(A组),2009年1月至2011年12月采用双侧标准外伤大骨瓣减压术66例(B组),将两组患者的颅内压、术后并发症及预后情况进行比较分析。结果采用双侧标准外伤大骨瓣减压术组较单纯病灶侧标准外伤大骨瓣减压手术组颅内压下降更明显,差异有统计学意义(P<0.01),按GOS治疗结果,B组良好率较A组提高了17.2%,B组病死率较A组下降13.2%(P<0.05)。结论双侧标准外伤大骨瓣减压术可有效降低特重型颅脑损伤患者的病死率及急性脑膨出和脑梗死的发生率,对改善特重型颅脑损伤患者的预后,提高其生存质量起到了积极的作用。

Clinical analysis of the most severe craniocerebral injury treated by bilateral standard large trauma craniectomy

Objective To investigate the effect of bilateral standard large trauma craniectomy on the most severe craniocere- bral injury. Methods The clinical data of 130 cases of the most severe craniocerebral injury underwent standard large trauma craniectomy were analyzed retrospectively, from Jan. 2006 to Dec. 2011. Among them, 64 cases were treated by unilateral standard large trauma eraniectomy from Jan. 2006 to Dec. 2008 （ group A） , and 66 cases were treated by bilateral standard large trauma craniectomy from Jan 2009 to Dec 2011 （ group B）. The intracranial pressure, prognosis and complications were compared between the two groups. Results Postoperative intracranial pressure （ICP） was significantly lower in group B than that in group A, there was significant difference （P 〈0.01 ） ; By Glasgow Outcome Scale （GOS） , the mortality rate of group B was 13.2% lower, and better outcome rate of group B was 17.2% higher than those of group A （P 〈 O. 05 ）. Conclusion Bilateral standard large trauma craniectomy could effectively bring down the mortality and the incidences of acute encephalocele and brain infarc- tion, it can improve the prognosis and life quality of patients with the most severe craniocerebral injury.