标准大骨瓣减压术在重型颅脑损伤中的临床应用

Clinical study of the standard large trauma craniotomy on severe brain injury

目的探讨标准大骨瓣开颅减压术治疗重型颅脑损伤的疗效。方法分别采用标准大骨瓣与常规减压手术治疗重型颅脑损伤病人54例,比较其预后。结果标准大骨瓣组24例,其中死亡6例(25%),重残/植物状态9例(37.5%)和中残/良好8例(33.3%)。常规骨瓣组30例,其中死亡13例(43.3%),重残/植物状态13例(43.3%),中残/良好5例(16.7%),两组中残/良好率、病死率差异有统计学意义(P<0.05)。结论标准外伤大骨瓣减压术比常规骨瓣减压术可使脑组织得到充分减压,有效保护脑功能,明显改善重型颅脑损伤患者的预后,降低病死率。

Objective To evaluate the value of the standard large trauma craniotomy in severe brain injury. Methods To compared the outcomes of the standard large craniotomy with the routine craniotomy in 54 severe traumatic brain injured patients. Resealts According to GOS, the results showed that 8 cases in the standard large craniotomy group had a good outcome or moderate disability （33.3%）, 9 patients were severe disability or in a vegetative state （37.5%）, 6 cases died （25%）. The standard large craniotomy group had 5 cases with a good outcome or moderate disability （16.7%）, 13 patients were severe disability or in a vegetative state （43.3%）, 13 cases died （43.3%）. The fatality rates of standard large trauma craniotomy group were lower than those in the routine craniotomy （P〈0.05）. Conclusion The standard large trauma craniotomy reduced pressure technique effectively protects the brain function by reducing the full pressure trauma. This technique has shown distinct improvement of heavy craniocerebral injuries, which resulted in reducing the patient case fatality rate.