额颞部重度颅脑损伤并急性硬膜下血肿26例诊治体会

Experience in the treatment of 26 patients with severe craniocerebral injury of fronto-temporal area and acute subdural hematoma

目的:探讨微创穿刺术和扩大翼点入路去骨瓣减压术在额颞部重度颅脑损伤合并急性硬膜下血肿中的临床应用价值。方法:对26例额颞部重度颅脑损伤并急性硬膜下血肿患者首先利用YL-1型颅脑穿刺针穿刺排血,然后经扩大翼点入路开颅行血肿清除、去骨瓣减压术。结果:伤后6个月～1年随访,26例患者中,预后良好15例(57.7%);预后不良7例(26.9%);死亡4例(15.4%)。结论:早期行微创穿刺排血可以缓解颅内压,减轻脑组织移位,为开颅手术赢得时间;扩大翼点入路去骨瓣减压术对于额颞部重度颅脑损伤具有减压充分、便于海马钩回疝复位等优点。以上两种方法的联合应用能够降低病死率及病残率,提高治疗效果。

Objective： To study the clinical effect of microinvasive craniopuncture with YL-1 puncture needle and craniotomy via extended pterional approach on the patients with severe craniocerebral injury of fronto-temporal area and acute subdural hematoma. Methods： 26 cases with severe brain injury of fronto-temporal area and acute subdural hematoma received the following treatment in turn, the acute subdural hematoma was partly drained through microinvasive craniopuncture with YL-1 puncture needle. Then craniotomy via extended pterional approach was given to remove the hematoma and osseous flap. Results： Glasgow outcome scale showed that 15 cases got favorable outcome （57.7%）, 7 cases got unfavorable outcome cases （26.9%）, and 4 cases were dead （15.4%） during 6-12 months follow-up. Conclusion： The drainage of hematoma through microinvasive puncture with YL-1 needle reduces intracranial pressure and spare more time for further treatment. The method of craniotomy via extended pterional approach has the advantages of sufficicient decompression and helpful to the reposition of cerebral hernia. The combination of the treatments could decrease the mortality, disability rate, and improve the effect.