标准去骨瓣减压术治疗重型颅脑损伤38例疗效观察

目的观察标准去骨瓣减压术治疗重型颅脑损伤的疗效。方法2008年12月～2010年12月我院对74例重型颅脑损伤患者进行观察分析,两组术前、术后均给予脱水、抗炎、止血、脑神经保护等常规治疗,并尽早手术。全部患者根据采取手术方法的不同分为观察组38例（行标准去骨瓣减压术）和对照组（行传统去骨瓣减压术）36例两组,比较两组的疗效,并对两组的死亡原因进行分析。结果两组随访6个月后,观察组死亡率15．79％,总有效率为84．21％,而对照组的死亡率30．56％,总有效率为69．44％,观察组与对照组总有效率比较,差异有统计学意义（Х^2=6．432,P〈0．05）。结论标准去骨瓣减压术治疗疗效确切,可以明显改善患者的预后,降低患者的死亡率,优于传统开颅手术,值得临床广泛推广和应用。     

全椎板减压植骨钉棒固定治疗腰椎管狭窄症

目的探讨治疗老年性退行性腰椎管狭窄症手术的临床效果。方法自2004年1月至2008年10月对23例65岁以上的老年性退行性腰椎管狭窄症行胰椎后路全椎板减压、髓核摘除、椎弓根钉棒系统内固定加后路植骨融合术。结果23例病人随访3个月～3年,平均随访1．8年;治疗效果按改良Macanb法标准评定,优20例,良2例,差1例,优良率95．65％。结论腰椎后路全椎板减压、髓核摘除,椎弓根钉棒系统内固定加后路植骨融合术治疗老年性退行性腰椎管狭窄症的疗效满意。     

颅脑外伤去大骨瓣减压术后并发脑膨出、颅内血肿及脑梗死的临床分析

目的探讨颅脑外伤去大骨瓣减压术后主要并发症:脑膨出、新发颅内血肿或/和脑挫裂伤病灶扩大及脑梗死三者的发生率及其预后情况。方法对48例颅脑外伤去大骨瓣减压术后患者进行回顾性探讨。提出了自己测量脑膨出的方法;统计术后脑膨出的发生率,不同时间段测量脑膨出程度,术后新发颅内血肿或/和脑挫裂伤病灶扩大以及脑梗死等的发生率、部位;并与患者术前GCS评分、伤后六个月GOS评分进行分析。结果颅脑外伤去大骨瓣减压术后,(1)脑膨出发生率为77%,手术后14d脑膨出程度最显著。(2)新发颅内血肿或/和脑挫裂伤病灶扩大发生率为58.3%;其部位可以在手术野内、手术同侧非手术区甚至在手术对侧。(3)脑梗死发生率12.5%,均在手术侧。(4)本组伤后六个月GOS评分:死亡率10.4%;预后不良率56.2%(含植物生存率16.7%;重度残废率39.5%);预后较好率33.4%(含中度残废16.7%;恢复良好16.7%)。结论颅脑外伤去大骨瓣减压术后,脑膨出、新发颅内血肿或/和脑挫裂伤病灶扩大、脑梗死等的发生率高,虽然去大骨瓣减压术可以降低死亡率但植物生存率、重度残废率高,手术要慎重。     

重症颅脑损伤大骨瓣减压术治疗的效果观察

目的观察与分析重症颅脑损伤的手术治疗效果,以期提高临床疗效,促进患者神经功能恢复。方法将60例重症颅脑损伤者随机分为两组,对照组30例,采取传统去骨瓣减压术,实验组30例,给予大骨瓣减压术,观察两组术后日常生活能力分级和手术并发症发生率。结果实验组的日常生活能力分级评估预后显著好于对照组(P<0.05),手术并发症发生率显著低于对照组(P<0.01)。结论大骨瓣减压术治疗重症颅脑损伤的临床效果显著。     

外科治疗混合性脑卒中15例回顾性分析

目的探讨混合性脑卒中外科治疗有效治疗模式。方法回顾性分析15例经头颅CT确诊并经外科手术治疗的混合性脑卒中病例资料。结果出血梗死型12例行颅内血肿清除并去骨瓣减压术,一个月内死亡2例,余病例按脑卒中患者神经功能缺损程度标准评定疗效,基本治愈5例．好转3例,无效2例;梗死出血型3例,行去骨瓣减压并硬脑膜成形术,一个月内死亡1例,2例按脑卒中患者神经功能缺损程度标准评定疗效,均达基本治愈。结论混合性脑卒中病情危重,临床表现复杂,临床上多采用稳妥的中性治疗,但对于中性治疗不能控制的恶性高颅压或病情逐渐加重者适时采取手术,也可取得较好效果。     

标准大骨瓣减压术治疗大面积脑梗死20例临床分析

目的评价标准大骨瓣减压术治疗大面积脑梗死的临床疗效。方法回顾性分析2007年1月—2010年12月采用标准大骨瓣减压术治疗的20例大面积脑梗死患者的治疗效果。结果经1年随访,按照格拉斯哥预后评分(GCS),恢复良好10例,轻残4例,重残3例,植物生存1例,死亡2例。结论大面积脑梗死在内科保守治疗无效时,采用标准大骨瓣减压手术治疗,能有效缓解颅高压,明显改善患者愈后。     

多节段腰椎管狭窄症的治疗探讨

目的探讨多节段腰椎管狭窄症的手术方法,提出预防腰椎管狭窄症的措施。方法根据多节段腰椎管狭窄的成因、形式、范围和程度的不同采取不同的减压术式：全椎板切除治疗单纯中央管狭窄7例;全椎板切除＋小关节部分切除治疗严重的退变性中央管狭窄伴侧隐窝狭窄、神经根管狭窄和腰椎手术失败综合征（FBSS）引起的多节段继发性腰椎狭窄共12例：椎板间隙潜行扩大减压治疗椎板间水平的中央管狭窄伴侧隐窝狭窄、神经根管狭窄11例;半椎板切除和（或）交叉半椎板切除＋小关节部分切除治疗中央管一侧狭窄伴侧隐窝狭窄、神经根管狭窄8例;椎板开窗成形减压术治疗侧隐窝狭窄、神经根管狭窄20例。同时行椎间盘突出髓核摘除38例,合并腰椎不稳者行椎间、椎旁植骨融合或椎间融合器融合12例（内固定11例）。结果本组58例．平均随访3年9个月。疗效评定优良率862％。结论针对性减压治疗多节段腰椎管狭窄症手术疗效满意,并可减少继发性腰椎不稳和再狭窄发生率。     

Effect of decompressive hemicraniectomy in patients with acute middle cerebral artery infarction

Background/aim We aimed to determine in which cases this procedure may be more effective based on the data of patients who underwent decompressive hemicraniectomy (DHC).Material and methodsOverall, 47 patients who underwent DHC due to acute middle cerebral artery (MCA) infarction between January 2014 and january 2019 were retrospectively investigated. These patients were divided into two groups: those who died after DHC (Group A) and those who survived DHC (Group B). The groups were compared in terms of various parameters. We investigated whether the patient’s modified Rankin scale (mRS) status changed depending on age (> 60 and < 60 years).ResultsThe median age of all patients was 65 (37–80) years; groups A and B had median ages of 66.5 (37–80) and 61 (44–79) years (p = 0.111), respectively; 55.3% patients were male. The elapsed times until hospitalization after the onset of symptoms were 4.5 and 3 h in groups A and B, respectively (p = 0.014). The median GCS score at the time of admission was 7 (5–12) and 10 (8–14) in groups A and B, respectively (p = 0.0001). At the time of admission, 63.3% patients in group A had anisocoria, whereas no patient in group B had anisocoria (p = 0.0001). In postoperative period, 40% patients in group A and all patients in group B received AC/AA treatment. The survival of patients aged < 60 and > 60 years who underwent DHC for MCA infraction was 61.5% and 26.5%, respectively (p = 0,041). The median mRS of patients < 60 and > 60 years were 4 (1–6) and 6 (1–6), respectively (p = 0.018).Conclusion Age, DHC timing, and elapsed time until hospitalization or access to treatment directly affect the functional outcome and survival in MCA-infarcted patients who underwent DHC. In patients in whom the medical treatment fails, early DHC administration will increase survival without waiting for neurological worsening once herniation is detected radiologically.