标准外伤大骨瓣与常规颞顶瓣治疗重型颅脑损伤的疗效对比分析

目的观察比较标准外伤大骨瓣与常规骨瓣治疗重型颅脑损伤的临床效果。方法从2000年1月-2005年12月收治的行颞顶瓣开颅术的重型颅脑损伤患者中随机选取30例（常规骨瓣组），与2006年1月-2012年12月收治的行标准大骨瓣减压术的重型颅脑损伤患者中随机选取的30例（大骨瓣组）进行对照分析，所有患者均行cT扫描证实颅内损伤情况，术后治疗方案基本相同。观察比较大骨瓣组与常规骨瓣组患者疗效及术后并发症发生情况。结果根据GOS评分法，大骨瓣组30例患者中，恢复良好16例，中残5例，重残2例，植物生存2例，死亡5例；常规骨瓣组30例患者中，恢复良好7例，中残6例，重残6例，植物生存2例，死亡9例。大骨瓣组疗效明显高于常规骨瓣组。大骨瓣组术后脑梗死、脑膨出及脑积水的发生率分别为3．33％、6．67％和6．67％，术后并发症发生率明显低于常规骨瓣组，差异均有统计学意义（P〈0．05）。但2组患者术后癫痫、脑脊液漏及颅内感染的发生率无统计学差异（P〉0．05）。结论标准外伤大骨瓣开颅术治疗重型颅脑损伤疗效优于常规骨瓣开颅术，但仍存在颅内感染等部分术后并发症，仍需要临床上神经外科医生进一步探讨和解决。

Comparison of the efficacy between standard large trauma craniectomy and routine temporoparietal craniectomy to treat severe traumatic brain injury

Objective To compare the efficacy between standard large trauma craniectomy and routine temporoparietal craniectomy to treat severe brain injury. Methods 30 patients were randomly selected from those with severe traumatic brain injury who were enrolled from January 2000 to December 2005 and received routine temporoparietal craniectomy. Meanwhile, another 30 patients were randomly selected from those with severe traumatic brain injury who were enrolled from January 2006 to December 2012 and received standard large trauma craniectomy. A comparison was done between each group. Each patient underwent CT scanning to determine intracranial injury. They were also given the same treatment scheme after operation. Then the efficacy and postoperative complication in both group were observed. Results According the GOS scoring method, among 30 patients in the standard large trauma craniectomy group, 16 patients recovered well, 5 presented moderate deficit, 2 severe deficits, 2 vegetative state and 5 were dead. Among 30 patients from the routine tem- poroparietal craniectomy group, 7 patients recovered well, 6 presented moderate deficit, 6 severe deficit, 2 vegetative state and 9 were dead. Effects were significantly stronger in the stand large trauama craniectomy than in the routine group （ P 〈 0.05 ）. Furthermore, the incidence of post - operation cerebral infarction, encephalocele, and hydrocephalus in the stand- ard trauama craniectomy group was 3.33% , 6.67% and 6.67% respectively, which were remarkably lower than those in the routine group （P 〈 0.05 ）. However, no significant difference was observed after operation between both groups in terms of the incidences of seizure, eerebrospinal fluid leak and intracranial infection （ P 〉 0.05 ）. Conclusion Standard large trauma craniectomy presented better efficacy than routine temporoparietal craniectomy to treat severe brain injury. But postoperative complications including craniotomy intracranial infection still exist, which require further investigation.