常规骨瓣与标准外伤大骨瓣治疗重型颅脑损伤的临床比较

目的 比较常规骨瓣与标准外伤大骨瓣治疗重型颅脑损伤的临床效果.方法 将经CT扫描证实符合诊断标准的197例重型颅脑损伤患者,分为行常规骨瓣术组101例和行标准外伤大骨瓣术组96例,对比两组术后疗效、预后和并发症情况.结果 伤后6个月格拉斯哥预后评分,常规骨瓣组中预后较好20例（19.8%）,其中良好9例、中残11例,预后较差81例（80.2%）,其中重残39例、植物生存2例、死亡40例;标准外伤大骨瓣组中预后较好31例（32.3%）,其中良好19例、中残12例,预后较差65例（67.7%）,其中重残31例、植物生存6 例、死亡28例.两组比较差异有统计学意义（P＜0.05）.标准外伤大骨瓣组切口疝、脑梗死发生率明显低于常规骨瓣对照组（P＜0.05）,但两组病人术后脑积水、癫痫发生率均无显著差异（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临床效果好,术后切口疝、脑梗死发生率相对较低.

Clinical comparison between conventional bone flap and standard large trauma bone flap in the treatment of severe traumatic brain injury

Objective To compare the clinical effect between conventional bone flap and standard large trauma bone flap in the treatment of severe traumatic brain injury （STBI）. Method 197 cases of STBI proved by CT were divided into two groups： conventional bone flap group of 101 cases , and standard large trauma bone flap group of 96 cases. Result According to GCS of 6 months after, the prognosis was excellent in 20 cases（ among them, 9 was nice, 11 was medium） ,and bad in 81 case （among them, 39 was severely disable,2 was in plant state, and 40 was dead）in the conventional bone flap group. As for the standard large trauma bone flap group, the prognosis was excellent in 31 cases （ among them, 19 was nice, 12 was medium） ,and bad in 65 case （among them, 31 was severely disable,6 was in plant state, and 28 was dead）. The difference was statistically significant between the two group. Incidence rate of incisional hernia and cerebral infarction in standard large trauma bone flap group were obviously lower than those in conventional bone flap group, but the incidence rate of hydrocephalus and epilepsy of these two groups were not obviously different （P 〉 0. 05） . Conclusions Standard large trauma bone flap has better clinical effect in the treatment of STBI, for it has a relatively low incidence rate of incisional hernia and cerebral infarction.