重型颅脑损伤大骨瓣开颅减压术后的远期疗效分析

Analysis of long-term outcome of large craniectomy for severe traumatic brain injury

目的探讨标准外伤大骨瓣开颅术治疗重型颅脑损伤的远期效果。方法回顾性分析167例采用标准外伤大骨瓣开颅术治疗的重型颅脑损伤病人(大骨瓣组)的远期疗效,与采用常规开颅术治疗的42例病人(对照组)进行对比。结果大骨瓣组随访期内死亡21例,发生长期昏迷31例,慢性脑积水142例,脑穿通畸形43例,硬膜下积液145例,迟发性癫疒间58例,颅脑损伤后综合征55例。对照组死亡10例,发生长期昏迷4例,慢性脑积水20例,脑穿通畸形7例,硬膜下积液30例,迟发性癫疒间15例,颅脑损伤后综合征18例。大骨瓣组病死率低于对照组(P<0.05),长期昏迷、慢性脑积水、脑穿通畸形和颅脑损伤后综合征发生率高于对照组(P<0.05)。结论采用大骨瓣开颅减压术治疗重型颅脑损伤,远期病死率较低;早期昏迷发生率虽有所增加,但复苏率明显高于对照组;慢性脑积水、脑穿通畸形发生率增加,但通过采取积极治疗,如早期颅骨成形、脑脊液分流术等可获得较好的疗效,因而远期生活质量较对照组好。

Objective To summarize the long-term outcome of large craniectomy for severe traumatic brain injured patients. Methods The outcomes of large craniectomy in 167 （large craniectomy group） and routine craniectomy in 42 （control group） patients severe traumatic brain injury were respectively analyzed, and the results were compared. Results In large craniectomy group, death occurred in 21 patients, prolonged coma in 31, chronic hydrocephalus in 142, porencephalia in 43, subdural fluid collection in 145, delayed-onset epilepsy in 58, and posttraumatic syndrome in 55. In control group, death occurred in 10 patients, prolonged coma in 4, chronic hydrocephalus in 20, porencephalia in 7, subdural fluid collection in 30, and delayed-onset epilepsy in 15, and posttraumatic syndrome in 18. The case fatality of the large craniectomy group was significantly lower than that of the control group （P〈0.05）, and the incidence rates of prolonged coma, chronic hydrocephalus, porencephalia and post-traumatic syndrome were higher than those of the control group （P〈0.05）. Conclusion Large craniectomy may reduce the case fatality. The prolonged coma may increase, while the palinesthesia rate was also increased. Although some complications were more common in large craniectomy group, such as porencephalia and subdural fluid collection, they can be treated by cranial orthopedics or V-P shunt and the patient still has better long-term life quality.