大骨瓣减压联合天幕裂孔切开术治疗重型颅脑损伤的疗效及预后分析

目的 探究大骨瓣减压联合天幕裂孔切开术治疗重型颅脑损伤的临床效果.方法 采用随机数字表法将2014年8月至2016年5月在本院诊治的74例重型颅脑损伤患者分为两组,各37例;对照组实施血肿清除、去大骨瓣减压术,观察组在对照组基础上联合天幕裂孔切开术;通过比较两组患者的环池显露情况及脑积水、应激性溃疡和术后脑梗塞等并发症的情况评估患者的临床疗效;两组患者均随访6个月,并采用格拉斯哥预后分级评分(GOS)标准通过比较两组患者残疾、植物样生成及死亡等情况来评估患者的预后.结果 观察组脑积水发生率为5.41％、应激性溃疡发生率为16.22％、术后脑梗塞发生率为10.81％,均低于对照组(分别为21.62％、45.95％、40.54％),术后3d环池显露发生率为78.38％,高于对照组的16.22％;两组比较,差异均有统计学意义(均P＜0.05).两组患者治疗后轻残及植物样生成发生率比较差异均无统计学意义(均P＞ 0.05);观察组预后良好为51.35％,高于对照组的37.03％,重残及死亡发生率分别为5.41％、10.81％,低于对照组的21.62％、29.73％,差异均有统计学意义(均P＜ 0.05).结论 大骨瓣减压联合天幕裂孔切开术治疗重型颅脑损伤患者疗效显著,环池显露较早,并发症少,安全性高,预后情况较好,是一种治疗颅脑损伤患者安全有效的方案.

Decompressive craniotomy combined with tentorium cerebelli hiatus incision for severe craniocerebral injury

Objective To explore the clinical effect of decompressive craniotomy combined with tentorium cerebelli hiatus incision for severe craniocerebral injury.Methods 74 patients with severe craniocerebral injury treated at our hospital from August,2014 to August,2016 were selected as study objects and were randomly divided into an observation group and a control group,37 for each group.The control group treated by hematoma clearance and decompressive craniotomy and the observation group by hematoma clearance,decompressive craniotomy,and tentorium cerebelli hiatus incision.The clinical effects were evaluated comparing both groups' cistema ambiens exposure,hydrocephalus,stress ulcer,post-operative cerebral infarction,and other complications between these two groups.Both groups were followed up 6 months.GOS standard was used to evaluate the conditions of disability,plant-like generation,and death in both groups.Results In the observation group,The incidences of hydrocephalus,stress ulcer,and post-operative cerebral infarction were 5.41％,16.22％,10.81％ in the observation group and were 21.62％,45.95％,and 40.54％ in the control group (P ＜ 0.05).3 d after operation,the incidence of cistema ambiens was 78.38％ in the observation group and was 16.22％ in the control group (P ＜ 0.05).There were no statistical differences in the incidences of middle disability and plantlike generation between these two groups (P＞0.05).The favorable prognosis rate was 51.35％ in the observation group and was 37.03％ in the control group (P ＜ 0.05).The occurrence rates of severe disability and death were 5.41％ and 10.81％ in the observation group and were 21.62％ and 29.73％ in the control group,respectively(P ＜ 0.05).Conclusions Decompressive craniotomy combined with tentorium cerebelli hiatus incision for severe craniocerebral injury is effective and safe,gets cistema ambiens exposure early and good prognosis,and causes few complications,so it is a safe and effective scheme for patients with craniocerebral injury.