标准大骨瓣开颅减压术治疗创伤后脑肿胀23例

23 cases of traumatic brain swelling treated in with standard large trauma craniotomy

目的总结标准大骨瓣开颅减压术治疗创伤后脑肿胀的治疗经验。方法治疗组23例采用美国标准大骨瓣开颅并去大骨瓣减压术治疗,骨窗大小为(6~8)cm×(10~12)cm;对照组31例采用传统的开颅术及减压骨窗,骨窗大小均在6 cm×8 cm以下。结果治疗组病死率8.70%,致残率26.09%;对照组病死率38.71%,致残率25.81%。治疗组术后平均清醒时间比对照组缩短(P<0.05),病死率与对照组比较差异有显著性。(P<0.05),致残率与对照组比较无显著差异(P>0.05)。结论尽管大骨瓣减压术目前尚有争议,但是它仍是创伤后颅内高压治疗的一个重要方法 ,能缩短术后清醒时间,降低病死率。

Objective To summarize our expenence in treating traumatic brain swelling with American standard large decompressive craniectomy.MethodsThe therapeutic group of 23 cases,in whom the American standard large decompressive craniectomy was used and the size of bone window was(6～8)cm×(10～12)cm.31 casses in the control group were treated with traditional craniectomy,the size of which was less than 6cm×8cm.ResultsThe mortality and morbidity in the theapeutic group were 24.14% and 22.41%,respectively,as compared with 28.33% and 30% in the control group.The mean time of becoming consciousness in the therapeutic group is significantly shorter than that of control group(P0.05).The GOS scale at the end of hospital stay and follow-up in the therapeutic grouo was better than that of control group(P<0.05).ConclusionAlthough the tole of large decompressive craniectomy is still in controversy to those with traumatic brain swelling.The key issues are indication and timing of surgical inrervention.Following treatment,selecting effective decompressive ctaniectomy will improve the outcome,shorten the time coma,and down the mortality.