扩大翼点入路术与传统手术治疗额颞对冲性颅脑损伤的疗效和预后比较

目的：比较扩大翼点入路术与传统手术治疗额颞对冲性颅脑损伤的疗效和预后，为临床治疗提供依据。方法采用回顾性研究，选择额颞对冲性颅脑损伤患者112例，根据手术方式分为扩大翼点入路术组58例（观察组）和传统手术组54例（对照组）。观察和评价两组术后GOS分级，比较术前和术后第1、3、6天颅内压及术后两组预后结果。结果观察组植物生存率为10．34％（6/58），低于对照组的27．78％（15/54）（χ2＝4．58，P＜0．05）；观察组中残率为29．31％（17/58），高于对照组的16．67％（9/54）（χ2＝4．20， P＜0．05）；观察组重度脑水肿为10．34％（6/58），低于对照组的20．37％（11/54）（χ2＝4．78，P＜0．05）；观察组硬膜下积液为12．07％（7/58），低于对照组的24．07％（13/54）（χ2＝3．96，P＜0．05）；观察组术后第1、3天颅内压分别为（302．18±17．33）mmH2O和（260．32±17．42）mmH2O，低于对照组的（371．24±18．40）mmH2O和（322．17±16．28）mmH2O（t＝7．53、5．39，均P＜0．05）。结论扩大翼点入路术能够充分清理创面，最大限度地清除血肿，止血较彻底，有利于脑功能的保护，对于提高患者的生存质量有重要临床价值。

Comparison on therapeutic efficacy and prognosis evaluation of extended pterional approach operation with the traditional operation treatment for frontotemporal contrecoup craniocerebral injury

Objective To compare on therapeutic efficacy and prognosis evaluation of extended pterional approach operation with the traditional operation treatment for frontotemporal contrecoup craniocerebral injury , and provide the clinical basis for the treatment.Methods By retrospective study,112 patients with frontotemporal contrecoup craniocerebral injury were selected randomly .There was extended pterional approach operation group （ observation group,58 cases） and traditional operation treatment group （the control group,54 cases）.We observed and evaluated indexes including of postoperative GOS grade assessment ,intracranial pressure measurement of 1,3,6 day preoperative and postoperative and the outcomes after operation of two groups .Results The plant survival rate of the observation group was 10.34%（6/58）,lower than that of the control group 27.78%（15/54）,the difference was significant （χ2 =4.58,P〈0.05）;The residual rate in the observation group was 29.31%（17/558）,more than that of control group 16.67%（9/54）,the difference was significant （χ2 =4.20,P〈0.05）;The severe brain edema of the observation group was 10.34%（6/58）,lower than that of the control group 20.37%（11/54）,the difference was significant （χ2 =4.78,P〈0.05）;Subdural effusion of the observation group was 12.07%（7/558）,lower than that of the con-trol group 24.07%（13/54）,the difference was significant（χ2 =3.96,P〈0.05）.The intracranial pressure of observa-tion group after 1 days and 3 days after operation were（302.18 ±17.33）mmH2O and （260.32 ±17.42）mmH2O,low-er than that of the control group was （371.24 ±18.40）mmH2O and （322.17 ±16.28）mmH2O,the difference was significant（t=7.53,5.39,all P〈0.05）.Conclusion Extended pterional approach could clean wound and hemato-ma fully,bleed thoroughly ,and be conducive to the protection of brain function .It is important for the clinical value to improve the quality of life of patients .