去骨瓣减压术治疗脑挫裂伤的临床疗效分析

目的观察去骨瓣减压术治疗脑挫裂伤的短期及长期疗效,并进一步分析不同大小骨窗的疗效差别。方法104例脑挫裂伤患者进行去骨瓣减压术(decompressed craniectomy,DC)治疗,观察手术前后颅内压变化及头颅CT中线移位和基底池形态改变以判定减压术的短期效果;分析3个月后Glasgow outcome score(GOS)预后评分以判定减压术的长期效果;按骨窗范围大小分为大骨瓣组和中等骨瓣组,分析两组的疗效差异。结果脑挫裂伤患者进行去骨瓣减压术后,能有效地降低颅内压于270 mmH2O以下,P<0.05;术后第3天、第7天颅内压与术前颅内压相比,均有明显下降,P<0.05;手术后颅脑CT显示的中线移位程度与基底池形态较术前CT均有明显改善,P<0.05;中等骨瓣组术后第3天颅内压较大骨瓣组为低,P<0.05;但第7天颅内压两组无明显差异(P>0.05);患者伤后3个月随访结果:恢复良好50例(48.1%)、轻残16例(15.4%)、重残14例(13.4%)、植物生存3例(2.9%)、死亡21例(20.2%),而且统计分析得出中等骨瓣组预后优于大骨瓣组,P<0.05;大、中等骨瓣组的常见手术并发症急性脑膨出、术后迟发性颅内血肿、术后外伤性癫痫、切口疝、颅内感染均无明显差异,P>0.05。结论脑挫裂伤患者进行去骨瓣减压术能有效地降低颅内压及改善CT影像学征象,能明显降低死亡率和重残率,从而改善脑挫裂伤患者的短期及长期疗效;早期进行中等骨瓣减压术的疗效优于大骨瓣组。

Therapeutic effect of decompressed craniectomy on cerebral trauma

Objective To prospectively investigate on the short and long-term effects of decompressed craniectomy(DC) on brain trauma and discuss the effective difference between large and moderate bone flaps.Methods All 104 patients with brain trauma were treated with DC and the alteration of intracranial pressure(ICP),middle line structure shift and basal cistern of CT imaging were compared.All patients' Glasgow outcome scores(GOS) were analysed at month 3 after DC.All patients were divided into both large and moderate bone flap groups according to the area of DC and the effects of the two groups were analysed.Results ICP decreased signifcantly below 270 mmH_2O after DC in all cases of brain trauma(P<0.05). The shift of middle line structure and basal cistern of CT imaging were improved(P<0.05).ICP was lower in moderate flap group than in large flap group at day 3 after DC(P<0.05).But ICP had no difference between the two groups at day 7 after DC(P>0.05).GOS at 3 month follow-up,50 cases got complete recovery(48.1%),16 moderate deficit(15.4%),14 severe deficite(13.4%),3 vegetative status(2.9%) and 21 died((23.6%)).There was no difference between the large and moderate flap groups about some common complications(P<0.05).Conclusion DC can significantly decrease the ICP,improve the conditions of CT imaging.It has good short and long-term effects.Early moderate flap DC has better clinical effects than large flap DC.