大骨瓣开颅手术治疗急性复合型硬膜下血肿52例报告

Clinical reports of 52 cases of decranium by large bone flap on acute compound subdural hematoma

目的:探讨大骨瓣开颅手术治疗急性复合型硬膜下血肿的治疗效果。方法:选用改良的Kelly问号切口,前界至发际中线,后至顶结节,下至耳屏前1cm;骨窗直径约10cm×12cm-12cm×15cm大小,充分暴露额叶前外侧及底部、外侧裂区、颞叶底部及顶叶,直视下彻底清除硬膜下积血及糜烂挫碎坏死的脑组织,必要时行充分的内外减压。结果:随访6个月,生存37例,占71.2%。其中康复良好23例,占44.3%;中度残废9例,占17.3%;重度残废3例,占5.8%;植物生存2例,占3.8%;死亡15例,占28.8%。结论:大骨瓣开颅手术治疗急性复合型硬膜下血肿,能充分暴露,彻底清除硬膜下积血及挫碎糜烂坏死的脑组织,减压充分,使患者顺利度过术后脑水肿期,提高治疗效果,降低病死率。

Objective ：To explore the therapeutic effect of decranium by large bone flap to treat acute compound subdural hematoma. Methods ：Revised Kelly incision was adopted from the former hairline to parietal tuber, the diameter of bone window was about 10cm × 12cm -12cm × 15cm. We exposed the anterior-lateral and basal part of frontal lobe,lateral cleft zone, basal part of temporal lobe and parietal lobe, then subdural hematoma and necrotic and erosed brain tissue were disruptly cleared, and decompression was operated in necessity. Results：After 6 months follow-up, 37 cases survived （71.2 % ）,of which 23 cases well rehabilitated （44. 3%）, 9 cases were moderately disabled （17. 3%）, 3 cases were severely disabled （3.8%）. And 15 cases died（28.8%）. Conclusion： Decranium by large bone flap to treat acute compound subdural hematoma can disruptly clear subdural hematoma and necrotic and erosed brain tissue. The effective method has an advantage of good exposure and ample decompression ,it can make the patient cross the stage of brain edema successfully, and it can improve the therapeutic results and reduce the fatality rate.