去骨瓣减压造成继发性脑损伤54例临床分析

Clinical analysis of secondary brain damage of 54 cases after decompressive craniectomy

目的探讨去骨瓣减压术引起继发性脑损害的原因和解决方法.方法1994/2004收治的颅内血肿行额颞部去骨瓣减压患者267例,根据骨窗大小将所有患者分为3组,Ⅰ组5cm×7cm^6cm×11cm(n=72),Ⅱ组7cm×12cm^11cm×14cm(n=103),Ⅲ组12cm×15cm以上(n=92),记录术前、术后早期血肿对侧上肢运动或语言功能与术后的比较.结果发生继发性脑损害54例.中等大小骨窗的病例继发性损害的发生率为35.9%(37/103),较小或较大的骨窗继发性损害的发生率较低,分别为10.3%(7/72)和10.9%(10/92),修补硬膜者无继发性损害.结论继发于去骨瓣减压的脑损害应引起注意,中等大小骨窗的病例较易发生.保护静脉,保护功能区上方的骨瓣和减张修补硬膜是预防继发性脑损害发生的好方法.

AIM： To study the causes of secondary brain injury and how to treat the injury after decompressive craniectomy. METHODS： Two hundred and sixty-seven intracranial hematoma patients with frontal-temporal decompressive craniectomy, were divided into 3 groups according to the size of the bone window group Ⅰ ,5cm×7cm×～6 ×11 cm （n=72） ; groupⅡ , 7 cm×12 cm-11 cm×14 cm （ n = 103 ） ; group Ⅲ 12 cm × 15 cm or larger. Language function and upper limb motor function opposite to the side of hematoma before and after operation were recorded and compared, RESULTS： Secondary brain damage happened in 54 of all the patients, 35.9% （37/103） patients with medium-sized bone window had secondary brain damage, while the incidence of secondary brain damage for patients with smaller or larger size of bone window was 10. 3% （7/ 12） and 10. 9% （ 10/92）, respectively. No such damage was observed in those patients whose dura had been repaired, CONCLUSION： Attention should be paid to the brain damage after decompressive craniectomy. The patients with medium-sized bone window have a high incidence rate of secondary brain damage. Protecting the vein and bone flap above functional domain and repairing the dura are good solutions to prevent the secondary brain injury,