标准大骨瓣减压并侧脑室颞角开放治疗重型创伤性颅脑损伤85例疗效分析

目的探讨标准大骨瓣减压并同侧脑室颞角开放治疗重型颅脑损伤的疗效。方法回顾性分析我院2003年7月~2013年7月收治的245例重型颅脑损伤行标准大骨瓣减压患者,其中标准大骨瓣减压并颅内血肿清除或额极颞极切除及侧脑室颞角开放85例(A组),标准大骨瓣减压并颅内血肿清除或额极颞极切除90例(B组),单纯标准大骨瓣减压70例(C组)。记录所有患者的性别、年龄、术前格拉斯哥昏迷评分(GCS)、受伤至手术的时间、瞳孔大小、CT表现、血压、动脉血氧分压、血糖等临床资料和6个月后的格拉斯哥预后评分(GOS)。根据GOS分级,比较A、B、C三组之间6个月后的疗效。结果 A、B、C三组存活者6个月后GOS良好或轻-中度残疾的比率分别是23.5%、20.0%、20.0%,GOS重度残疾或植物生存的比率分别是50.6%、47.8%、40.0%,A、B、C三组的死亡率分别是25.9%、32.2%、40.0%。运用SPSS 15.0统计软件,经Ridit分析显示:F=3.37,P=0.0371。结论对于重型颅脑损伤,在降低死亡率方面,标准大骨瓣减压并颅内血肿清除或额极颞极切除及侧脑室颞角开放优于标准大骨瓣减压并颅内血肿清除或额极颞极切除和单纯标准大骨瓣减压,但没有明显提高6个月后良好或轻-中度残疾的比率。

Efficacy of standard large trauma craniotomy combined with temporal horn opening of lateral cerebral ventricle in 85 patients with severe traumatic brain injury

Objective To study the efficacy of standard large trauma craniotomy combined with temporal horn opening of lateral cerebral ventricle in severe traumatic brain injury .Methods Retrospective analysis was ap-plied to 245 cases of severe traumatic brain injury treated with standard large trauma craniotomy from Jul .2003 to Jul.2013 in our hospital.Patients in group A(n=85)were treated with standard large trauma craniotomy and in-tracranial hematoma removal or frontal and temporal pole resection ,and lateral cerebral ventricle temporal horn open-ing.Patients in group B(n=90)were treated with standard large trauma craniotomy and intracranial hematoma re-moval or frontal and temporal pole resection .Patients in group C(n=70)was treated with only standard large trau-ma craniotomy.Clinical data were collected such as gender,age,preoperative GCS(Glasgow coma scale),time length from injury to operation,pupil size,CT(computer tomograph),BP(blood pressure),arterial partial pressure of oxygen,and glucose.Based on the GOS(Glasgow outcome scale),the treatment efficacy at 6 months after operation was compared among the three groups .Results The rates of good or mild to moderate disability of group A ,B and C were 23.5%, 20.0%, 20.0%, respectively;the rates of severe disability or persistent vegetative state were 50.6%,47.8%,40.0%,respectively;and the mortality rates were 25.9%,32.2%,40.0%,respectively .Ridit a-nalysis with the application of SPSS 15.0 statistical software showed F =3.37 and P=0.0371.Conclusion In se-vere traumatic brain injury ,the efficacy of standard large trauma craniotomy accompanied with intracranial hematoma removal or frontal and temporal pole resection , and temporal horn opening of lateral cerebral ventricle is better in mortality decrease than the other two treatments of standard large trauma craniotomy and intracranial hematoma re -moval or frontal and temporal pole resection and merely standard large trauma craniotomy ;yet such treatment fails to increase the rate of good or mild to moderate disability at 6 months after surgery .