标准大骨瓣开颅同步行硬膜减张缝合治疗重型颅脑损伤

Clinical use of standard trauma maximus bone flap craniotectomy decompression with intraoperative enlarged duraplasty synchronously for treating frontal-temporal severe cranocerebral injury

目的探讨标准外伤大骨瓣开颅减压术同步术中行硬膜减张缝合修补治疗重型额颞部颅脑损伤的疗效。方法将136例符合手术治疗的重型颅脑损伤病人随机分为A组(行标准外伤大骨瓣开颅同步术中行硬膜减张缝合修补)和B组(传统去骨瓣减压硬膜敞开),调查术后并发症发生情况、后期对颅骨修复的影响及术后6个月根据GCS评价进行疗效判断。结果A组并发症脑积水、硬膜下积液、脑脊液漏、外伤性癫痫发生率明显低于B组;A组颅骨修复手术平均时间短、平均术中出血量少、术中植片下积液少等差别较B组有显著意义;A组恢复良好率高于B组,A组重残及死亡率低于B组,差别有显著意义。结论标准外伤大骨瓣开颅减压术同步术中行硬膜减张缝合修补是治疗重型颅脑损伤的较好方法,可降低死亡率,提高病人的生存质量。

Objective To probe into the curative effect of standard trauma maximus bone flap craniotectomy decompression with intraoperative enlarged duraplasty synchronously for treating severe frontal-temporal cranocerebral injury. Methods 136 patients with severe frontal-temporal craniocerebral injury for operation were divided into A group （ n = 73, Standard trauma maximus bone flap cranio- tectomy decompression with intraoperative enlarged duraplasty synchronously） and B group （ n = 63, Routine decompressive craniectomy with dura open I-The curative effectiveness was assessed according to the post-operative complication＇s the influence of later repairing defect of skull, GCS scores. Results The study of post-operative complication, the influence of later repairing defect of skull and GCS scores after 6 months follow-up show A group have better curative effectiveness than B group. Conclusion Standard trauma maximus bone flap craniotectomy decompression with intraoperative enlarged duraplasty synchronously is a preferable means of treating with severe frontal-temporal craniocerebral injury,which can help to decrease mortality rate and to improve patients＇living quality.