脑疝复位术救治外伤性颞叶钩回疝

目的探讨脑疝复位技术或天幕裂孔切开术对外伤后嵌顿性颞叶钩回疝的救治效果。方法对56例外伤性颅内血肿合并脑疝者应用脑疝复位技术或天幕裂孔切开处理嵌顿性颞叶钩回疝,并与29例常规手术对照组患者进行比较。结果脑疝复位组56例中,恢复良好25例,中残7例,重残5例,迁延性昏迷4例,死亡15例;预后较好（良好＋中残）者占57.1%（32/56）,死亡率为26.8%（15/56）。常规手术对照组29例中恢复良好5例,中残2例,重残5例,迁延性昏迷3例,死亡14例;预后较好（良好＋中残）者占24.1%（7/29）,死亡率为48.3%（14/29）。两组患者死亡率及恢复较好（良好＋中残）者所占比例与对照组比,有显著性差异（P〈0.05）。结论发生脑疝嵌顿时,对于单侧瞳孔散大时间在2h以上,或已经出现双侧瞳孔散大但持续时间在1h以内者,结合脑疝复位或天幕裂孔切开术,能显著改善病人的预后。

Treatment of Traumatic Temporal Uncinate Herniation by Reduction of Hernia Cerebri

Objective To explore the curative effects of the reduction of hernia cerebri and incision of the tentorium cerebelli hiatus on the incarcerated traumatic temporal uncinate herniation. Methods The clinical data of 56 patients with traumatic intracranial hematoma accompanied with incarcerated uncinate herniation treated by the reduction of hernia cerebri or incision of the tentorium cerebelli hiatus （observed group） were analyzed retrospectively. Their clinical data were compared with those of 29 patients with traumatic intracranial hematoma accompanied with intracranial uncinate hematoma who served as control and were treated by only standard large trauma craniotomy. Results Of 56 patients in the observed group, 25 were recovered well, 7 were moderately disabled, 5 were severely disabled, 4 had prolonged coma, and 15 died. Of 29 patients in the control group, 5 were recovered well, 2 were moderately disabled, 5 were severely disabled, 3 had prolonged coma, and 14 died. The rate （57.1%, 32/56） of good prognosis （good recovery ＋ moderately disabled） was significantly higher in the observed group than that （24.1%, 7/29） in the control group （P0.05）. The mortality （26.8%, 15/ 56） was significantly lower in the observed group than that （48.3%, 14/29） in the control group （P0.05）. Conclusion The reduction of the hernia cerebri and incision of the tentorium cerebella hiatus may improve the prognoses in the patients with traumatic intracranial hematomas accompanied with temporal uncinate herniation.