额颞部对冲性脑损伤的临床特点与治疗分析

目的:探讨额颞部对冲性脑损伤的临床特点、手术指征、手术时机及手术方式。方法:回顾分析320例额颞部对冲性脑损伤的临床表现、影像学检查、手术指征、术后处理及预后。手术治疗260例,非手术治疗60例。手术采用改良翼点开颅血肿清除术,其中去骨瓣减压194例,骨瓣复位或漂浮复位66例。气管切开106例,亚低温治疗45例。结果:恢复良好225例,中残32例,重残15例,植物生存状态3例,死亡45例。结论:伤后进行性意识障碍,CT显示一侧或两侧额颞广泛脑挫伤并硬膜下血肿,持续较长时间脑水肿是其临床特点。伴有脑干损害时,意识障碍重,昏迷时间较长。弥漫性脑肿胀、脑室受压、环池闭塞者预后差。改良翼点开颅是理想的手术方式。大骨瓣减压联合亚低温治疗能显著提高重型额颞脑损伤抢救成功率。

Analysis for Feature and Treatment of Frontal - temple Lobe Contre - coup Injury

Objective To explore clinical feature, operation indication , operation time and mode of frontal - temple lobe centre - coup injury. Method We retrospectively study the clinical manifestation, image examination, operation indication, postoperative care and prognosis in 320 cases. 260 cases were treatmented by operation and other 60 cases by non - operative treatment. Clearance of hematoma by craniotomy with modified pterional approach was used. Among them , 194 cases were depression by removing bone flap and 66 cases' bone flap were reposition or floatation reposition. 106 cases were tracheotomy and 45 cases were sub - hypothermia treatment. Results 225 cases were good recovery, 32 cases middle disabled and 15 cases severe disabled, 3 cases made vegetative state and 45 cases died. Conclusion The clinical features were progressive consciousness after injury, unilateral of bilateral extensive frontal - temple lobe cerebral contusion accompany subdural hematoma and cere-bral edema for a long time. If brain stem was involved, disorder of consciousness was wevere and coma was longer. Those who diffuse brain swelling, cerelral Ventrcles compression and cisterna ambiens occlusion had a worse prognosis. Craniotomy by modified pterional approach was a ideal operation mode. Decompression by large bone flap accompany sub - hypothermia treatment can rise the rate of rescues obviously to severe frontal - temple lobe injury.