小脑幕裂孔切开术治疗脑疝的有关问题探讨

Study of tentorium cerebelli hiatus incision on the treatment of tentorial herniation

目的探索更安全、简便的小脑幕裂孔切开方法。方法对1994年7月至2006年10月收治的136例重型特重型颅脑伤合并有颞叶钩回疝患者在开颅清除血肿去骨瓣的基础上加行小脑幕裂孔切开术，采用正确的切口、合适的体位，使用特制的钩刀。结果GCS3～5分51例，6～8分85例，恢复良好72例（52．9％），中残21例（15．4％），重残16例（11，8％），植物生存8例（5．9％），死亡19例（14．0％）。结论安全、简便的小脑幕裂孔切开术可进一步改善脑疝患者的预后。

Objective To explore safer and more convenient operative method of tentorium cerebelli hiatus incision on the treatment of severe brain injury complicated with tentorial herniation. Method Tentorium cerebelli hiatus incision was made consuming proper incision, head position and distinctive bush-hook on 136 patients of severe and most severe brain injury complicated with tentorial herniation from July 1994 to October 2006. Results 51 cases were classified in GCS score 3 - 5, 85 cases in GCS score 6 - 8. 72 cases （52.9%） were survived in good condition, 21 cases （15. 4% ） had moderate disability, 16 cases （11.8%） had severe deficit, 8 cases （5.9%） were in vegetative and 19 cases （14.0%） were dead. Conclusion Patients consumed safe and convenient operative method of tentorium cerebelli hiatus incision could have a good prognosis.