改良标准大骨瓣开颅术治疗重型颅脑损伤

目的在标准外伤大骨瓣开颅术的基础上加以改良，提高重度颅脑损伤病人的救治效果。方法本组有78例病人采用标准外伤大骨瓣开颅，在手术显微镜下清除血肿及受损脑组织，彻底止血，引流管从外侧裂处尽量深入以达到或接近鞍上池，将额顶部骨瓣或全部骨瓣用丝线网织漂浮固定。结果本组存活70例，根据GCS：康复良好46例，中残16例，重残7例，植物生存1例，死亡8例。骨瓣浮出高度、复位时间与脑脊液压力检测基本吻合，可达到充分减压的目的，骨瓣愈合情况较为理想。结论改良标准外伤大骨瓣开颅术适用于绝大多数重度颅脑损伤病人，对于术中恶性脑膨出，脑组织膨出骨窗2cm者本法不适用。

Modified Standard Large Trauma Craniectomy for Severe Craniocerebrai Injury

Objective Standard large trauma craniectomy was improved to elevate the curative effect of the severe traumatic brain injured patients.Methods 78 severe traumatic brain injured patients were cured by standard large trauma craniectomy,with microscope,clean out the hematoma and damaged brain.After stanch completely ,taking the pipe to get through sylvian fissure for pipeting the suprasellar pool,frontoparietal bones or all bones were floatable fixed up by theads.Results 70 cases were survival, by Glasgow outcome scale,46 cases got good recovery,16 cases had moderate deficits ,7 cases got severe deficits,1 case was in persistent vegetable status,8 cases were dead.Height of bones'floation and time of reposition was almostly according to the intracranial pressure,the floatable bones could decrease the pressure plentifully,the bones healed up well.Conclusion The modified standard large trauma craniectomy can be used for most severe craniocerebral injured patients,except for those whose brains severely exceed the window of bones by 2 centimeters or more.