超低位大骨瓣开颅颞肌下减压术对重型颅脑创伤脑疝的疗效分析

目的探讨和比较超低位大骨瓣开颅颞肌下减压术治疗重型颅脑创伤并发脑疝的临床疗效。方法回顾性分析2008年4月~2012年4月于上海交通大学医学院附属仁济医院神经外科就诊的80例重型颅脑创伤并发脑疝患者,将其分为实验组40例和对照组40例,对照组采用标准大骨瓣减压术治疗,实验组采用超低位大骨瓣开颅颞肌下减压术。结果对照组颅内压（48.4±5.2）mm Hg,格拉斯哥昏迷评分（GCS）（9.6±3.1）分,实验组颅内压（30.9±4.1）mm Hg,GCS为（12.9±3.2）分,实验组颅内压低于对照组,GCS评分高于对照组,差异均有统计学意义（均P〈0.05）。对照组中线移位恢复有效率72.5%,实验组有效率100.0%,实验组中线移位恢复有效率高于对照组,差异有统计学意义（P〈0.05）。实验组治疗后死亡率（17.5%）低于对照组（50.0%）,差异有统计学意义（P〈0.05）。结论超低位大骨瓣开颅颞肌下减压术治疗重型颅脑创伤脑疝患者可以促使中线移位恢复,降低患者颅内压,显著改善患者预后,适合临床推广应用。

Clinical analysis of large craniotomy decompression/very low position decompression under temporal muscle surgery in treatment of severe craniocerebral trauma accompanied with cerebral hernia

Objective To investigate the clinical effect of large craniotomy decompression/very low position decompression under temporal muscle surgery in treatment of severe craniocerebral trauma accompanied with cerebral hernia.Methods 80 cases of severe craniocerebral trauma accompanied with cerebral hernia were analyzed and divided retrospectively in affiliated Renji hospital of Shanghai Jiaotong university school of medicine from April 2008 to April 2012.All patients were divided into control group and test group with 40 cases in each group,patients in control group were treated with standard large craniotomy decompression surgery,patients in control group were received large craniotomy decompression/very low position decompression under temporal muscle surgery.Results The intracranial pressure of control group was（48.4±5.2） mm Hg and GCS score was（9.6±3.1） scores,the intracranial pressure of test group was（30.9±4.1） mm Hg and GCS score was（12.9±3.2） scores,the intracranial pressure of test group was found lower than that of control group,GCS score of test group was found higher than that of control group,the differences were all statistically significant（all P 0.05）.The effective midline shift rate of test group（100.0%） was found than that of the control group（72.5%）,the difference was statistically significant（P 0.05）.The mortality rate after treatment of test group（17.5%） was found lower than that of control group（50.0%）,the difference was statistically significant（P 0.05）.Conclusion Large craniotomy decompression/very low position decompression under temporal muscle surgery in treatment of severe craniocerebral trauma accompanied with cerebral hernia can promote the shift midline,cut down the intracranial pressure and improve the prognosis of patients.It is worthy of clinical application.