标准大骨瓣开颅治疗重型颅脑损伤32例疗效分析
Standard large trauma craniotomy for treatment of severe traumatic brain injury:a report of 32 cases
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摘要: 目的：比较标准大骨瓣开颅与常规骨瓣开颅治疗重型颅脑损伤的临床疗效。方法：62例重型颅脑损伤患者随机分为治疗组32例和对照组30例。对照组采用传统的开颅术及去骨瓣减压同时硬膜敞开，骨窗大小为6 cm8 cm；治疗组采用标准大骨瓣开颅术治疗，开颅并去骨瓣减压治疗，骨窗大小为12 cm15 cm，术中同步行硬膜减张缝合修补。比较2组术后颅内压变化、并发症的发生率及预后。结果：术后半个月，治疗组患者颅内高压连续3 d发生率为12.5%，低于对照组的33.3%(P0.05)；2组外伤性脑梗死、脑组织切口疝、外伤性癫痫、外伤性脑积水发生率差异均无统计学意义(P0.05)；治疗组中残以上康复率为84.4%，对照组为60.0%，治疗组预后效果优于对照组(P0.05)。结论：采用标准大骨瓣开颅术治疗重型颅脑损伤，能够显著减少脑神经损伤，保留脑功能，降低并发症发生率，比常规骨瓣开颅术减压效果更明显，疗效更好。
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关键词:
- 颅脑损伤 /
- 标准外伤大骨瓣开颅术 /
- 预后
Abstract: Objective:To compare the clinical efficacy of standard large trauma craniotomy and routine temporoparietal craniectomy in treatment of severe traumatic brain injuries.Methods:Sixty-two patients with severe traumatic brain injuries were randomly divided into treatment group(n=32) and control group(n=30).The control group underwent routine craniectomy and decompressive craniectomy together with dura opening with the bone window size of 6 cm8 cm.The treatment group received large trauma craniotomy and bone disc decompression craniotomy with the bone window size of 12 cm15 cm.Epidural relaxation suture repair was performed simultaneously during the operation.The postoperative intracranial pressure,complication rate and prognosis of the two groups were compared.Results:Half a month after the operation,the incidence of 3 d continuous intracranial pressure of the treatment group was 12.5%,which was lower than that of the control group(33.3%)(P0.05).There was no significant difference in traumatic cerebral infarction,complication of brain tissue incision hernia,traumatic epilepsy and traumatic hydrocephalus between the two groups(P0.05).The recovery rate of moderate disability was 84.4% in the treatment group and 60.0% in the control group.The prognosis of the treatment group was better than that of the control group(P0.05).Conclusions:Standard large trauma craniotomy can significantly reduce the brain damage,preserve the brain function and decrease the incidences of complications.It is more effective than the routine temporoparietal craniectomy for treatment of severe traumatic brain injuries.-
Key words:
- traumatic brain injury /
- standard large trauma craniotomy /
- prognosis
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