外伤大骨瓣开颅术治疗外伤后急性脑肿胀的临床研究

Comparative study of standard large trauma craniectomy and routine temporoparietal craniectomy in treating acute posttraumatic brain swelling

目的 评价标准外伤大骨瓣开颅术在治疗外伤后急性脑肿胀的临床作用。方法 将74例伴中线移位≥5mm的外伤后急性脑肿胀患者随机分为标准外伤大骨瓣开颅术组和常规开颅术组．前瞻性分析比较两组患者手术后的颅内压、1个月内的病死率、1年后的GOS评分和并发症。结果 大骨瓣开颅术组患者在伤后24、48、72、96h的平均颅内压较常规开颅术组明显降低（P〈0．01）；两组1个月内病死率分别为27％和57％，外伤后1年的GOS评分比较差异有统计学意义，其中预后较佳（GOS为4～5分）率分别为56．8％和32．4％，发生硬膜下血肿率分别为22％和5％（P〈0．05）。结论 标准外伤大骨瓣开颅术是治疗外伤后急性脑肿胀病人的有效方法，具有降低颅内压、降低病死率、改善预后的作用，但发生硬膜下血肿的可能性增加。

Objective To investigate the clinical effects of standard large trauma craniectomy in patients with acute posttraumatic brain swelling. Methods A cohort study was performed in 74 patients of acute posttraumatic brain swelling with midline shifting more than 5 mm, who were divided randomly into two groups： standard large trauma craniectomy group （n = 37） and routine temporoparietal craniectomy group as control group （n = 37）. The vital sign, the intracranial pressure （ICP） and complications were observed during the treatment. The Glasgow outcome scale （GOS） and mortality rate as well as the complications were evaluated after treatment. Results The mean ICP in the large trauma craniectomy group at 24, 48, 72 and 96 hours was much lower than those of the control group （P 〈0.01 ）. The mortality rates at 1 month after treatment were 27 % in the large trauma craniectomy group and 57 % in the control group （P 〈0.01）. The good recovery （GOS score of 4 - 5） rates after 1 year of injury were 56.8% in large trauma craniectomy group and 32.4% in control group （P〈 0.05）. The rates of subdural hematoma were 22 % and 5 % respectively （ P 〈 0.05）. Conclusion The standard large trauma craniectomy is a sate and effective therapy way for patients with acute posttraumatie brain swelling, which can reduce the mortality and improve the neurological outcomes. However, the rate for subdural hematoma .seems high.