标准大骨瓣开颅术在治疗重型颅脑损伤中的临床应用探讨

目的探讨标准大骨瓣开颅术在治疗重型颅脑损伤中的临床应用价值。方法回顾性分析我院2009年至2011年间我院收治的55例重型颅脑损伤患者的临床资料,所有患者均行标准大骨瓣开颅术治疗,并观察临床疗效。结果本组55例患者术后行头部CT复查发现,53例（96.4%）血肿消失,另有2例血肿较术前有所缩小,所有患者脑部均未出现新的出血。术后发生迟发性血肿4例,脑脊液切口漏2例,脑积水2例,癫痫1例,并发症发生率为16.4%。术后随访3～6个月,恢复良好39例（70.9%）,中残8例（14.5%）,重残3例（5.5%）,植物生存2例（3.6%）,死亡3例（5.5%）。结论大骨瓣开颅术具有骨窗大、手术暴露范围广、内外减压充分等特点,治疗重型颅脑损伤临床疗效显著,具有很好的临床应用价值,值得进一步推广使用。

Standard Large Bone Flap Craniotomy in Treatment of Severe Head Injury in Clinical Application

Objective To explore the standard large trauma craniotomy in the treatment of severe head injury in clinical application.Methods retrospective analysis of our hospital from 2009 to 2011 years in our hospital,55 cases of severe craniocerebral injury patients with the clinical data,all the patients underwent standard large bone flap craniotomy treatment,and observation of clinical efficacy.Results In the group of 55 patients undergoing head CT review found that,in 53 cases（96.4%） hematoma disappeared,another 2 cases of hematoma compared with preoperative narrows somewhat,all patients with brain did not appear the new hemorrhage.The incidence of postoperative delayed intracranial hematoma in 4 cases,incisional CSF leakage in 2 cases,2 case of hydrocephalus,1 cases of epilepsy,the complication rate was 16.4%.After a follow-up of 3 to 6 months,good recovery in 39 cases（70.9%）,moderate disability in 8 cases（14.5%）,severe disability in 3 cases（5.5%）,plant survival in 2 patients（3.6%）,3 cases died（5.5%）.Conclusion Craniotomy with large bone flap with bone window is large,wide range of internal and external decompression operation exposure,full features,treatment of severe craniocerebral injury with significant clinical effect,has good clinical application value,it is worth to further promote the use of.