对冲性双额叶脑挫裂伤临床探讨

目的探讨对冲性双额叶脑挫裂伤及脑中心疝的发病机制、临床表现及手术时机。方法回顾性分析2003年1月至2008年6月间以枕部着力致双侧额叶脑挫裂伤者27例,采取动态头颅CT检查,在发现脑中心疝前预见性开颅手术,并以常规冠状开颅手术治疗双额叶脑挫裂伤。结果本组经保守及手术治疗存活23例,死亡4例,死亡原因为脑疝晚期。按GCS评分良好19例,中残3例,重残1例。结论密切观察对冲性双额叶脑挫裂伤患者的意识、瞳孔等变化,强调动态头颅CT观察,放宽手术指征,尽早预见性去骨瓣减压手术和常规冠状开颅手术。

Clinical study on bifrontal contrecoup contusion

Objective To summarize the clinical rescue experience in patients with opposite blast contused laceration of bilateral basal frontal lobes resulted from putting forth force onto occiput.Methods 27 patients,admitted from Jan,2003 to Jun,2008,suffered from opposite blast contused laceration of bilateral basal frontal lobes resulted from putting forth force onto occiput were summarized and analyzed retrospectively.Results All cases were estimated with GCS：19 cases were cured excellently ;3 cases were medium disabilities;1 case was severe disabilities;23 cases were survived,4 cases died.Conclusion Early repeated cranial CT examination,early craniotomy to clear hematoma in frontal lobes base,removal of bone flap for decompression,and elimination of intracranial high pressure are the keys to relieve the prognosis in patients with opposite blast contused laceration of bilateral frontal lobes.