双侧去骨瓣减压术在救治双侧不对称性重型颅脑损伤中的临床研究

目的探讨双侧去骨瓣减压术在救治双侧不对称性重型颅脑损伤中的临床疗效。方法选取我院2008年4月～2011年12月收治的双侧不对称性重型颅脑损伤患者61例,随机分为两组,采用单侧标准外伤大骨瓣手术治疗患者30例为对照组,采用双侧去骨瓣减压术治疗患者31例为观察组,治疗3个月后患者均行格拉斯哥预后评分（GOS）,比较两组患者各项临床指标及预后情况。结果治疗后,观察组与对照组颅内压均明显降低,观察组颅内压明显低于对照组。观察组术中急性脑膨出发生率、术后切口疝发生率均明显低于对照组。观察组良好率（35.5%）明显高于对照组（13.3%）,观察组病死率（9.7%）明显低于对照组（40.0%）。观察组术后并发症发生率（16.1%）明显低于对照组（46.7%）,差异均有统计学意义（P〈0.05）。结论双侧去骨瓣减压术在救治双侧不对称性重型颅脑损伤中可以明显改善患者的临床指标及预后情况,降低患者颅内压、术中急性脑膨出发生率、术后切口疝发生率、术后并发症发生率、病死率,值得临床推广使用。

Clinical research of bilateral decompressive craniectomy in treating bilateral asymmetrical severe craniocerebral injury

Objective To investigate the clinical efficacy of bilateral decompressive craniectomy in the treatment of bilateral asymmetrical severe craniocerebral injury.Methods 61 cases of patients with bilateral asymmetrical severe craniocerebral injury,who treated in our hospital from April 2008 to December 2011,were randomly divided into two groups.30 patients in control group were cured with unilateral standard large trauma craniotomy,31 patients in observation group were cured with bilateral decompressive craniectomy.And the Glasgow Outcome Score(GOS) was evaluated for all patients in both groups 3 months after treatment,then every clinical index and prognosis of patients were compared between two groups.Results After treatment,intracranial pressure of patients in both groups reduced significantly,and intracranial pressure of patients in observation group was significantly lower than that in control group.Incidence of acute intraoperative encephalocele and incidence of postoperative incisional hernia of observation group patients were significantly lower than that of control group patients.Good rate(35.5%) of observation group patients was significantly higher than that of control group patients(13.3%).Case fatality rate(9.7%) of observation group patients was significantly lower than that of control group patients(40%).Postoperative complication rate(16.1%) of observation group patients was significantly lower than that of control group patients(46.7%).All the differences were statistically significant(P < 0.05).Conclusion Bbilateral decompressive craniectomy in the treatment of bilateral asymmetrical severe craniocerebral injury patients can significantly improve the clinical indices and prognosis of those patients,and reduce the intracranial pressure,the incidence of acute intraoperative encephalocele,the incidence of postoperative incisional hernia,the incidence of postoperative complications and the case fatality rate of patients.And it is worthy to recommand its clinical application.