控制性减压术治疗重型、特重型颅脑损伤

目的探讨控制性减压术治疗重型、特重型颅脑损伤的临床疗效。方法将80例重型、特重型颅脑损伤病人按半随机原则等分为两组，治疗组行术中控制性减压术，对照组行常规骨瓣开颅术。术后随访6个月，GOS预后评分4-5为预后良好，1-3分为预后不良。结果治疗组发生术中急性脑膨出3例，迟发性颅内血肿4例，脑梗死2例。对照组发生术中急性脑膨出10例，迟发性颅内血肿12例，脑梗死3例。两组急性脑膨出和迟发性颅内血肿发生率差异均有统计学意义（P〈0．05），而脑梗死发生率差异无统计学意义（P〉0．05）。随访6个月，治疗组GOS4。5分23例，1.3分17例；对照组GOS4-5分13例，1-3分27例；两组预后良好率差异有统计学意义（P〈0．05），预后不良率差异无统计学意义（P〉O．05）。结论控制性减压术能有效降低重型、特重型颅脑损伤病人并发症的发生率，改善病人预后。

Treatment of severe or extra-severe craniocerebral injuries by controlled decompression

Objective To investigate the clinical efficacy of controlled decompression for severe or extra severe-craniocerebral injuries. Methods Eighty patients with severe or extra-severe craniocerebral injuries were equally divided into two groups by semi-random principle. The controlled decompression was performed in the treatment group and conventional craniotomy in the control group. The patients were followed up for 6 months, 4 to 5 scores were good prognosis and 1 to 3 scores were poor prognosis according to GOS scores. Results The acute intraoperative encephaloceles occurred in 3 patients, delayed intracranial hematoma in 4 and cerebral infarction in 2 in the treatment group, while acute intraoperative encephaloceles occurred in 10 patients, delayed intracranial hematoma in 12 and cerebral infarction in 3 in the control group. The significant differences were found in the incidence rate of acute intraoperative encephaloceles and delayed intracranial hematoma between two groups （P 〈 0.05）, and no significant difference in the incidence rate of cerebral infarction between two groups （P 〉 0.05）. The patients were followed up for 6 months, the GOS scores were as follows： 4 to 5 scores in 23 patients and 1 to 3 scores in 17 in the treatment group, while 4 to 5 scores in 13 patients and 1 to 3 scores in 27 in the control group. The significant differences were found in good prognosis rate between two groups （P 〈 0.05）, and no significant difference in poor prognosis rate between two groups （P 〉 0.05）. Conclusion The controlled decompression can decrease the complication rates and improve the prognosis for patients with severe or extra-severe craniocerebral injuries.