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目的探讨冠状切口双侧去骨瓣减压术在治疗重型颅脑损伤中的作用。方法冠状双侧去骨瓣减压术治疗重型颅脑损伤19例,回顾性分析患者的临床表现、影像学表现、手术前后的颅内压数值及患者预后情况。结果本组患者19例均行手术治疗,术前患者的ICP平均值为(38.26±14.85)mmHg。手术中骨瓣去除后,ICP降至(16.63±7.87)mmHg;硬膜剪开后,ICP进一步降至(7.16±2.73)mmHg;手术后,患者ICP轻度升高至(12.95±3.49)mmHg,但仍低于初始ICP数值(P〈0.05)。所有患者平均随访时间为(6.4±1.2)月,根据GOS评分,恢复良好13例,重度残疾3例,植物生存2例,死亡1例,病死率为5.26%。结论冠状切口双侧去骨瓣减压术能够有效、快速地降低重型颅脑损伤患者的颅内压,改善患者的预后。 相似文献
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目的探讨双侧去骨瓣减压术治疗急性颅脑损伤的效果。方法选取郏县人民医院收治的82例急性颅脑损伤患者,根据不同治疗方案分为2组,各41例。对照组采取改良大骨瓣开颅减压术,观察组采取双侧去骨瓣减压术。结果术后第1天、3天、5天,2组的颅内压均较术前降低,但观察组显著低于对照组;观察组预后良好率高于对照组。差异均有统计学意义(P0.05)。结论双侧去骨瓣减压术治疗急性颅脑损伤,可有效降低颅内压和改善预后效果。 相似文献
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目的探讨改良去骨瓣减压术治疗重度颅脑损伤的效果。方法对65例重度颅脑损伤患者实施改良去骨瓣减压术治疗,观察手术时间、术中出血量、颅内压恢复正常时间、并发症发生率、术后住院时间。结果本组手术时间(52.61±14.41)min,术中出血量(93.20±25.46)m L,颅内压恢复正常时间(3.60±1.70)h,术后住院时间(14.38±2.18)d,并发症发生率为7.69%(5/65)。按GOS标准评分:预后良好24例,中残25例,重残9例,植物生存4例,死亡3例。结论改良去骨瓣减压术治疗重度颅脑损伤,术中出血量少、并发症发生率低、术后康复快,效果满意。 相似文献
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目的探讨改良去大骨瓣减压术治疗重型颅脑损伤的效果。方法选择郑州市第七人民医院收治的56例重型颅脑损伤患者,将2016-07—2017-12间采用标准去大骨瓣减压术的26例患者作为对照组,将2018-01—2019-04间采用改良去大骨瓣减压术的30例患者作为改良组。回顾性分析患者的临床资料。结果2组患者术后均获6个月随访,其间改良组并发症发生率低于对照组,差异有统计学意义(P<0.05)。末次随访依据GOS评分标准评定疗效,改良组恢复良好率高于对照组,差异有统计学意义(P<0.05)。结论改良去大骨瓣减压术可有效改善重型颅脑损伤患者的预后。 相似文献
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目的分析重型颅脑损伤一侧去骨瓣减压术后对侧迟发型颅内血肿发生的原因并提出预防和处理的方法。方法回顾性分析本院经治的12例出现重型颅脑损伤一侧去骨瓣减压术后对侧迟发型颅内血肿患者的病例特点、治疗经过和预后情况,并结合文献对该手术并发症进行分析。结果 12例患者均行再次开颅手术清除对侧迟发性颅内血肿术。术前CT提示对侧合并颅骨骨折6例,术中出现术侧急性脑膨出并证实对侧迟发性血肿8例。术后3月随访,患者预后良好1例,中残3例,重残5例,死亡4例。结论重型颅脑损伤一侧去骨瓣减压术后对侧迟发型颅内血肿多发生在首次术后24小时内,对于术前CT提示存在对侧颅骨骨折、术中出现急性脑膨出等情况的患者,应当高度警惕该并发症的发生。及时的发现并手术治疗是争取良好预后的关键。 相似文献
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目的:探讨基层医院双侧去骨瓣减压术中脑组织医源性损伤的发生机制。方法回顾性分析2006年6月至2012年1月,本院133例双侧去骨瓣减压术患者的临床资料,其中97例采用气钻、铣刀开颅的患者作为观察组,另36例采用手摇颅钻、线锯开颅的患者作为对照组。记录两组患者的后手术侧手术时间,对比研究两组患者的非预期再次手术率及病死率。结果观察组术后行非预期再次手术22例,其中先手术侧再次手术17例(后手术侧手术时间118±21分钟),后手术侧再次手术5例。对照组非预期再次手术15例,先手术侧再次手术12例(后手术侧手术时间144±25分钟),后手术侧再次手术3例。观察组死亡25例,对照组19例。观察组的非预期再次手术率及病死率显著低于对照组。两组的先手术侧非预期再次手术率均显著高于后手术侧。差异有统计学意义(P〈0.05)。结论在双侧去骨瓣减压术中,“重力-时间”因素及后手术侧开颅时产生的暴力对先手术侧脑组织的损伤是导致术中医源性损伤的主要原因。先进手术器械的合理使用及脑保护理念的始终贯彻,能显著减少术中脑组织医源性损伤,降低术后非预期再次手术率及病死率。 相似文献
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《The Surgical clinics of North America》2017,97(5):1015-1030
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目的:探讨重型颅脑损伤去骨瓣减压术减少术后并发症的手术防治方法.方法:39例重型颅脑损伤患者,中线移位大于0.5 cm者29例.单侧去骨瓣20例,双侧去骨瓣9例.额颞去骨瓣后将硬脑膜做成向额顶和向颞顶掀起的硬膜瓣,关颅时将硬膜瓣与颢肌骨面减张缝合,封闭硬膜腔.结果:术后3 d内CT复查:骨窗后缘处隆起脑组织钝角移行34... 相似文献
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黄煌渊 《中国骨与关节损伤杂志》1999,(5)
临床发现合并脑外伤昏迷的骨折患者骨痂形成时早量多质硬,这将直接关系到骨折的治疗与愈合。如何治疗该类患者仍存在争议。传统认为先制动患肢,待脑外伤救治完毕后再手术治疗骨折;近来不少作者强调应在48h内完成骨折的手术治疗。通过分析124例重症脑外伤昏迷患者不同时机手术治疗骨折的利弊,认为上述观点不利于该类患者的全身救治,而应在生命体征基本稳定情况下尽早手术治疗骨折。认为重症脑外伤患者合并肢体骨折比较复杂,手术治疗骨折的时机应根据创伤的具体情况来选择。 相似文献
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Primary purpose: There is a need to develop reliable outcome measures to determine well-being after brain injury. In 1997, Teasdale et al. published the European Brain Injury Questionnaire (EBIQ), a self-report and relative-report measure of the subjective experience of cognitive, emotional and social difficulties experienced by people with brain injury. It is now used in several rehabilitation centres as an outcome measure, but its test-re-test reliability has yet not been determined. The primary purpose of the present study is to establish this degree of reliability.
Research design: The EBIQ was administered twice within an ∼1-month period to 50 people with brain injury, to 20 relatives of people with brain injury and to 51 normal controls.
Results: The results showed significant and satisfactory test-re-test reliabilities for all three groups across all nine EBIQ scales (r = 0.55-0.90).
Conclusion: It is concluded that the EBIQ is a clinically reliable measure to determine the subjective well-being of people with brain injury and to assess change of subjective concerns over time. 相似文献
Research design: The EBIQ was administered twice within an ∼1-month period to 50 people with brain injury, to 20 relatives of people with brain injury and to 51 normal controls.
Results: The results showed significant and satisfactory test-re-test reliabilities for all three groups across all nine EBIQ scales (r = 0.55-0.90).
Conclusion: It is concluded that the EBIQ is a clinically reliable measure to determine the subjective well-being of people with brain injury and to assess change of subjective concerns over time. 相似文献
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颅脑损伤病人社会支持状况调查 总被引:9,自引:1,他引:8
目的 了解颅脑损伤病人的社会支持情况。方法 应用社会支持评定量表对69例神志清醒的颅脑损伤(观察组)病人进行调查,与61例同期住院的骨外伤(对照组)病人比较。对颅脑损伤病人取其均数45分为界,低于45分为社会支持度低,高于45分为社会支持度高,进行统计。结果 颅脑损伤病人的社会支持总分为(45.53±8.23)分,骨外伤病人的社会支持总分为(37.36±11.34)分,两组差异有显著性意义(t=4.66,P40岁和未婚者社会支持度偏低,护士应对这部分病人加强关注与支持。 相似文献
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四肢骨折合并颅脑伤治疗十年回顾(附138例报告) 总被引:2,自引:0,他引:2
张雪非 《中国矫形外科杂志》2003,11(23):1603-1605
目的:回顾评价10年来四肢骨折合并颅脑伤的治疗。资料与方法:分析四肢骨折合并颅脑伤的治愈者138例(男117例,女21例;年龄8~71岁,平均32.3岁)的治疗经过,按颅脑伤程度、骨愈合、及并发症情况评估治疗结果。结果:手术内固定组112例:正常骨愈合(平均9.8周)89例,手术切口渗血4例,感染17例,内固定钢板螺丝钉折断2例。骨牵引组11例,出现股骨成角2例,牵引针孔感染2例,腓总神经牵拉伤1例。石膏固定组15例,出现骶尾部压疮1例,股骨缩短成角畸形2例。结论:四肢骨折合并颅脑伤应将颅脑伤治疗放在首位,骨折可采取手术或非手术方法治疗。合并颅脑伤的四肢骨折骨愈合较一般骨折骨愈合时间缩短,治疗过程中感染、出血倾向等并发症应特别加以防治。 相似文献
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Missori P Rastelli E Polli FM Tarantino R Rocchi G Delfini R 《Acta neurochirurgica》2002,144(9):917-920
Summary.
Background: In patients submitted to suboccipital craniectomy in whom the bone is not repositioned, there may be a significant aesthetic
defect due to lack of bone tissue, sometimes accompanied by paresthaesia and painful symptoms.
Method: In 15 patients submitted to suboccipital craniectomy, the bone chips were repositioned during wound closure.
Findings: At a mean follow up of 19 months (from 6 to 36 months), 2 patients (13%) complained of mild wound discomfort or occasional
local pain. Twelve patients underwent control CT-scan. In three cases (25%) the bone fragments had been partly reabsorbed
whereas in the other 9 (75%) they either formed a thin (4 patients) or consistent (5 patients) bony wall, with variable degree
of adaptation to the contour of the contralateral occipital bone. The best cosmetic and functional results were obtained in
young patients in whom the cerebellar parenchyma was well-preserved, as opposed to those in whom a CSF collection had replaced
areas of cerebellar tissue.
Interpretation: In the majority of cases in whom an osteoplastic suboccipital craniotomy is not possible, repositioning of the bone chips
from suboccipital craniectomy is able to restore a bone table, thus allowing morphological and functional recovery of the
occipital region.
Published online September 2, 2002
Correspondence: Missori Paolo, M.D., Neurotraumatologia, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy. 相似文献
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Objective: To present our experience in using decompressive craniectomy (DC) among severe traumatic brain injury (TBI) patients during operation and to discuss its indication.Methods:From October 2008 ... 相似文献