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标准外伤大骨瓣与常规骨瓣治疗重型颅脑损伤多中心前瞻性临床对照研究 被引量:526

Efficacy of standard large trauma craniectomy for severe traumatic brain injured patients with tentorial herniation: a multicenter prospective randomized controlled study
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摘要 目的比较标准外伤大骨瓣与常规颞顶瓣开颅术在治疗447例重型颅脑损伤合并脑挫裂伤脑水肿、恶性颅内高压病人的效果。方法6家医院神经外科共收治符合标准的重型颅脑损伤病人447例,分为两组:(1)标准外伤大骨瓣组217例;(2)常规骨瓣组230例。所有病人都经CT扫描证实颅内损伤状况。结果伤后6个月临床随访结果:标准外伤大骨瓣组:76例预后较好(35.0%),其中恢复良好42例、中残34例;141例预后较差(65.0%),其中重残69例、植物生存9例、死亡63例;常规骨瓣组:58例预后较好(25.2%),其中恢复良好31例、中残27例;172例预后较差(74.8%),其中重残80例、植物生存7例、死亡85例(P<0.05)。标准外伤大骨瓣治疗组病人颅内压下降速度和程度优于常规骨瓣对照组(P<0.05)。标准外伤大骨瓣治疗组病人的迟发性血肿、再次手术、切口疝和脑脊液漏发生率明显低于常规骨瓣对照组(P<0.05),但两组病人术后急性脑膨出、术后外伤性癫痫和颅内感染发生率均无显著差异(P>0.05)。结论临床前瞻性多中心对照研究证明标准外伤大骨瓣开颅术治疗严重脑挫裂伤脑水肿、恶性颅内高压病人的疗效优于常规颞顶瓣开颅术。 Objective To compare the effect of standard large trauma craniectomy versus routine temporoparietal craniectomy on outcome of 447 severe traumatic brain injured patients with tentorial herniation (GCS(8). Methods At 6 medical centers Four hundred forty seven patients with an admission Glasgow Coma Scale score of 8 or less were randomly divided into two groups:standard large trauma craniectomy group (n=217) got unilateral or bilateral frontotemporoparietal bone flap(12cm×15cm)and routine temporoparietal craniectomy group (n=230) received routine tem poroparietal scalp flap (6cm×8cm). All patients got their CT scan. Results Glasgow outcome scale at 6 month follow-up 76 cases got favorable outcome (35.0%) including 42 good recovery and 34 moderate deficit other 141 cases got unfavorable outcome (65.0%) including 69 severe deficits 9 persistent vegetative status and 63 were dead in standard large trauma craniectomy group. However only 58 cases got favorable outcome (25.2%) including 31 good recovery and 27 moderate deficit and other 172 cases were unfavorable outcome (74.8%) including 80 severe deficits 7 persistent vegetative status and 85 were dead in routine temporoparietal cranie ctomy group (P<0.05). Intracranial pressure decreased faster and better in stand ard trauama craniectomy than in routine craniectomy (P<0.05). Furthermore the incidence of delayed intracranial hematomas reoperation incisional hernia and CSF fistulae in standard trauma craniectomy group was lower than those in routine craniectomy group (P<0.05). However the incidence of acute encephalomyelocele traumatic seizure and intracranial infection was not significantly different between two groups (P>0.05). Conclusion Standard large trauma craniectomy significantly improves the outcome of severe traumatic brain injured patients with refractory intracranial hypertension which indicate that standard large trauma craniectomy but not routine temporoparietal craniectomy should be routinely performed in those patients who suffer from unilateral or bilateral tentorial hernia tion with frontotemporoparietal contusion and intracerebral or subdural hematomas.
出处 《中华神经外科杂志》 CSCD 北大核心 2004年第1期37-40,共4页 Chinese Journal of Neurosurgery
基金 上海市科委课题(编号:994119089)
关键词 标准外伤大骨瓣 常规骨瓣 治疗 重型颅脑损伤 多中心前瞻性 对照研究 预后 Severe traumatic brain injury Standard large trauma craniectomy Routine temporoparietal craniectomy Outcome
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