大骨瓣减压联合天幕裂孔切开术治疗外伤性天幕裂孔疝

目的：探讨大骨瓣减压联合天幕裂孔切开术治疗外伤性天幕裂孔疝患者的临床效果。方法：将本院2004年1月～2009年6月收治的符合标准的患者68例,分为两组。治疗组33例行血肿清除、大骨瓣减压及天幕裂孔切开术;对照组35例行血肿清除、大骨瓣减压,不行天幕裂孔切开术。术后48h复查CT,对比组间脑干周围池改善率。对比组间病死率、术后2周与4周的GCS评分,及术后6个月的GOS评分。结果：治疗组脑干周围池改善率明显高于对照组（P〈0.01）,病死率低于对照组（P〈0.05）,术后2、4周GCS评分及术后6个月的GOS评分优于对照组（P〈0.05）。结论：大骨瓣减压联合天幕裂孔切开治疗外伤性天幕裂孔疝疗效肯定,可显著降低患者的死亡率,改善预后。

Curative effect of decompressive craniectomy combined with tentorium cerebelli hiatus incision on patients with tentorium cerebelli hiatus herniation by traumatic brain injury

Objective：To study the curative effect of decompressive craniectomy combined with tentorium cerebelli hiatus incision on patients with tentorium cerebelli hiatus herniation by traumatic brain injury. Methods：In our hospital the standard of such treated 68 patients from January 2004 to June 2009,were divided into two groups. Treatment group, 33 cases were treated with hematoma removal, decompressive craniectomy and tentorium cerebelli hiatus incision; control group, 35 cases with hematoma removal, decompressive craniectomy, no tentorium cerebelli hiatus incision. 48 h after review CT, contrast groups around the pool to improve the rate of brain stem. Comparison of mortality between groups, after 2 weeks and 4 weeks of the GCS score, and at 6-month GOS score. Results： The treatment group around the pool to improve the rate of brain stem was significantly higher （P0.01）, mortality was lower than the control group （P0.05）, after 2, 4 weeks GCS score and GOS score after 6 months were better than the control group （P0.05）. Conclusion：Decompressive craniectomy combined with tentorium cerebelli hiatus incision on patients with tentorium cerebelli hiatus herniation by traumatic brain injury is effective and significantly reduce mortality and improve prognosis of the patients.