改良大骨瓣减压术治疗重型颅脑损伤的临床分析

Modified large trauma craniotomy for severe craniocerebral injury： a clinical analysis

目的探讨改良大骨瓣开颅内外减压手术治疗重型颅脑损伤患者的临床疗效。方法回顾性分析268例重型颅脑损伤患者的临床资料，其中应用改良大骨瓣开颅内外减压手术治疗（改良手术组）的患者152例，应用常规骨瓣开颅手术治疗（常规手术组）的患者116例，对比分析两组患者术后CT复查、颅内压监测和预后情况。结果改良手术组术后中线基本恢复者的比例（82．2％）明显高于常规手术组（41．4％），术后颅内压（30～35mmHg）较常规手术组（40～60mm Hg）明显下降，疗效（预后良好69例，预后不良56例，死亡27例）较常规手术组（预后良好40例，预后不良42例，死亡34例1更好，差异有统计学意义（P〈0．05）。结论改良大骨瓣开颅内外减压手术能有效降低重型颅脑损伤患者的颅内压，减少脑组织嵌顿，改善患者的预后。

Objective To explore the clinical effect of modified large trauma craniotomy （MLTC） for treatment of severe craniocerebral injury. Methods A retrospective analysis of the clinical data was conducted in 268 patients with severe cranioccrebral injury receiving MLTC （n=152） or conventional craniotomy （n=l 16）, and the results of postoperative CT, intracranial pressure monitoring and prognosis were comparatively analyzed. Results The patients undergoing MLTC showed a significantly higher recovery rate （82.2%） than those receiving conventional craniotomy （41.4%）, and the intracranial pressure was obviously lower in MLTC group （30-35 mm Hg） than in conventional craniotomy group （40-60 mm Hg）. In MLTC group, 69 patients had good clinical outcomes, 56 had poor outcomes and 27 died; 40 patients in the conventional craniotomy group had good clinical outcomes, 42 had poor outcomes and 34 died. Conclusion MLTC can lower the intracranial pressure, reduce incarceration of the brain tissue, and improve the prognosis of patients with severe craniocerebral injury.