标准大骨瓣与常规骨瓣治疗重型颅脑损伤临床分析

目的 比较标准大骨瓣与常规骨瓣开颅术治疗重型颅脑损伤合并脑挫裂伤脑水肿、恶性颅内高压患者的效果.方法 共收治重型颅脑损伤患者223例,行标准大骨瓣组 108 例,常规骨瓣组115例,均经 CT扫描证实颅内损伤状况.结果 伤后6个月临床随访结果:(1)标准大骨瓣组38例预后较好(35.19%), 70 例预后较差(64.81%);(2)常规骨瓣组29 例预后较好(25.22%), 86 例预后较差(74.78%).结论 标准大骨瓣治疗组患者的迟发性血肿、再次手术、切口疝和脑脊液漏发生率明显低于常规骨瓣组,可广泛用于治疗严重脑挫裂伤脑水肿、恶性颅内高压患者.

A comparison of standard large craniectomy with routine craniectomy in treatment of severe traumatic brain injuries

Objective To compare the outcomes of standard large craniectomy with routine craniectomy in 223 severe traumatic brain injured patients. Methods Two hundred and twenty-three patients were randomly divided into standard large craniectomy group (n=108) and routine craniectomy group (n=115).The traumatic brain injuries were all comfirmed by CT scan. Results The patients have been followed up for 6 months.The results showed that 38 cases in the standard large craniectomy group got favorable outcome(35.19%),and 29 cases in routine craniectomy group got favorable outcome(25.22%).Conclusion The rates of delayed hematomas, second operations, incisional hernia, and CSF rhinorrhea in standard large craniectomy group were lower than those in routine craniectomy. Standard large craniectomy could be applied in the patients with severe contusion and laceration of brain and intracranial hypertension.