标准外伤大骨瓣与常规骨瓣开颅术治疗重型颅脑损伤的疗效对比分析

目的比较标准外伤大骨瓣与常规骨瓣开颅术治疗重型颅脑损伤病人的效果。方法将我科2000年1 月-2006年1月手术的89例额颞顶重型颅脑损伤[Glasgow昏迷评分(GCS)3-8分]病人,分成两组,2000年1月- 2004年7月根据出血部位采用常规额颞或颞顶骨瓣开颅手术35例为常规骨瓣组,2004年8月-2006年1月采用标准外伤大骨瓣开颅手术54例为标准外伤大骨瓣组。所有病人均经CT证实颅内损伤情况。根据Glasgow预后评分(GOS) 评价病人预后。结果术后平均随访6个月,常规骨瓣组恢复良好13例,中残4例,重残2例,植物状态2例,死亡14 例。标准外伤大骨瓣组恢复良好22例,中残14例,重残4例,植物状态3例,死亡11例。排除了术前GCS评分、性别构成及发病至手术时间的影响,标准外伤大骨瓣治疗重型损伤疗效好于常规骨瓣开颅术,病死率明显降低(P<0．05)。结论标准外伤大骨瓣治疗重型颅脑损伤较常规骨瓣开颅术能明显降低重度颅脑损伤的病死率。

Comparative analysis of standard large trauma craniotomy and routine craniotomy for severe craniocerebral injury

Objective To compare the effect of standard large trauma craniotomy versus routine craniotmny on patients with severe craniocerebral injury. Methods Eighty - nine patients with fronto - temporo - parietal severe cranmcerebral injury (GCS≤8) in our department from January 2000 to January 2006 were divided into two groups. Thirty - five patients front January 2000 to July 2004 underwent temporo - parietal or fronto - parietal craniotomy according to the position of hematomasas a routine(RC) group. Fifty - four patients from Augest 2004 to January 2006 unzerwent standard large trauma craniotomy(SLTC)as a SLTC group.All patients got their CT scan. The prognosis of the patients was evaluated according to Glasgow outcome scale (GOS). Results With an average of 6 months follow - up,13 patients got good outcome, 4 patients got moderate disability ,2 patients got severe disability ,2 patients got vegetative survival and 14 died in RC group. Twenty - two patients got good outcome, 14 patients got moderate disability, 4 patients got severe disability, 3 patients got vegetative survival and 11 died in SLTC group. After excluding the influence of sex ,GCS before operation and the time from suffering from disease to operating, the effect of SLTC on severe craniocerebral injury was better than RC, the fatality rate of SLTC was lower significantly than RC(P<0.05). Conclusion SLTC reducing the fatality rate of patients with severe craniocerebral injury is more apparent than RC.