大骨瓣减压治疗重型颅脑损伤疗效分析

目的探讨大骨瓣减压比较常规骨瓣减压治疗重型、特重型颅脑损伤的疗效和优势。方法回顾性分析本科近年收治的263例重型颅脑损伤（GCS≤8分）患者，治疗组135例含特重治疗组（GCS≤5分）54例]采用标准大骨瓣开颅术减压，对照组128例（含特重对照组49例）采用常规骨瓣减压。术后6个月，比较GOS评定和并发症。结果治疗组有效96例（71.1％），对照组为75例（58.6％），P〈0.05；特重治疗组有效34例（63％），特重对照组为18例（36.7％），P〈0.01。治疗组在术后因继发颅内高压而再次手术的发生率低于对照组（P〈0.05），但术后迟发血肿和对侧硬膜下积液发生率多于对照组（P〈0，05）。结论大骨瓣减压治疗重型，尤其是特重型颅脑损伤，能提高治疗效率；减少因继发颅内高压而再次手术的发生；但术后迟发血肿和对侧硬膜下积液增多。

Analysis of the efficacy of large decompressive craniectomy in severe traumatic brain injury

Objective To investigate the role of large decompressive craniectomy(LDC) in the management of severe traumatic brain injury(TBI) and very severe TBI,compared with the routine decompressive craniectomy(RDC).Methods Clinical data on 263 patients with severe TBI who were treated by either LDC or RDC in our department were reviewed.One hundred and Thirty-five patients,including 54 very severe TBIs,underwent LDC.Another 128 patients,including 49 very severe TBIs,underwent RDC.Outcomes and postoperative complications of the two kinds of surgical management were compared and analyzed at 6 month follow-up.Results Ninty-six patients(71.7%) obtained effective outcome in the LDC group,while only 75 cases(58.6%) did so in the RDC group.Moreover,the efficacy of LDC to treat very severe TBI was also higher than that of RDC(63.0% vs.36.7%).The incidence of reoperation due to refractory intracranial pressure(ICP) in LDC was significantly lower than that in the RDC group(P<0.05),while the incidence of delayed intracranial hematoma and subdural effusion was significantly higher than that in the RDC group(P<0.05).Conclusion LDC had superiority over RDC in improving the outcome of severe TBI,especially the very severe ones.LDC also could efficiently reduce the chance of reoperation due to refractory ICP,but not the incidence of overall complications.On the contrary,it increased the incidence of delayed intra-cranial hematomas and contralateral subdural effusion.