标准大骨瓣减压术在重度颅脑损伤救治中的临床应用

Clinical application of standard large trauma craniotomy on patients with severe craniocerebral injury

目的:探讨标准大骨瓣减压术治疗重型颅脑损伤的临床疗效。方法:对2008年1月至2009年6月重型颅脑损伤86名患者,采用标准大骨瓣减压术,使其骨窗下界平颧弓并咬除蝶骨嵴以显露前、中颅窝,前至额极,后达乳突前。硬脑膜常采用减张缝合。结果:术后随访6个月,本组患者存活67例(77.90%),死亡19例(22.09%)。根据ADL(日常生活能力)分级法:Ⅰ级24例(27.90%),Ⅱ级26例(30.23%),Ⅲ级7例(8.13%),Ⅳ级5例(5.81%),Ⅴ级5例(5.81%)。结论:该方法骨窗范围大,挫伤的大脑半球可充分显露,有利于清除血肿和静脉回流,同时使损伤的大脑半球、侧裂血管得到充分减压,有效降低颅内压,减少脑组织嵌顿,有利于脑疝的解除。

Objective：To explore clinical curative effect of standard large trauma eraniotomy on severe eraniocerebral injury. Methods ：86 patients of severe craniocerebral injury from January 2008 to June 2009 were treated with standard large traumacraniotomy. Surgical procedure was initiated by extending the bone window to the descending horizontal boarder line of zygomatic arch with anteriorly going to frontal pole and posteriorly reaching frontal mastoid process and gouging off the crest of sphenoid bone for exposing both anterior and middle cranial fossa, and tension - reduced suture was used for cerebral dura mater. Results： Of all 86 cases, 67cases （77.90%） survived, 19 cases （22.09%） died after 6 months, according to ADL grade system, Ⅰ24 cases（27.90% ） ,Ⅱ26 cases （30.23%） , Ⅲ 7 cases （8.13%） , Ⅳ5 cases （5.81%） , Ⅴ5 cases （5.81%）. Conclusions： This method has wide bone window which exposes all the injury cerebral hemisphere. It is best for clearing away hematoma and venous return, and makes all the injured cerebral hemisphere and side blood vessel reduced pressure. It effectively reduces the pressure of intraeranial and the incarceration of brain tissue. It is best to cure cerebral hernia.