颅脑皮瓣环网状切开外减压术式的临床研究

Clinical study of exterior cranial decompression by scalp incising in net pattern

目的探讨颅脑皮瓣环网状切开外减压术式的临床应用价值。方法将GCS≤8评分的重型颅脑损伤并脑肿胀的42例患者,随机分为实验组(18例)和对照组(24例)。实验组采用去大骨瓣减压+硬脑膜减张缝合+皮瓣环网状切开术。对照组采用去大骨瓣减压+硬脑膜减张缝合术。术后进行连续七天的颅内压监测,将监测结果和病人的转归情况进行统计学分析。结果实验组的平均ICP(3.34±0.68)kpa,对照组平均ICP(3.81±0.70)kpa。实验组与对照组比较颅内压不同时段轻度增高(P<0.05);中度增高实验组与对照组无明显差异(P>0.05);对照组重度增高的比例明显高于实验组(P<0.05)。实验组近期疗效,恢复良好13例,不良5例。良好率72%。对照组恢复良好14例,不良10例。良好率58%。实验组良好率明显高于对照组(P<0.05)。实验组无脑脊液漏、皮瓣坏死、切口及颅内感染。结论颅脑皮瓣切开环网状减压术具有明显的减压效果和应用价值。

Objective To study the clinical effect of decompression procedure with the method of skin flap cutdown. Method According to the GCS,42 patients with severe craniocerebral trauma were divided into two groups. The experimental groups were exerted bone flap craniotomy and net like skin flap cutdown . The control groups were exerted bone flap craniotomy only. Intracranial pressure was monitored post-operation and the results were analyzed with statistic method. Results Intracanial pressure （ICP） of the experimental groups and the control groups were 3. 345：0.68 kpa and 3.81±0.70 kpa, respectively. ICP of the experimental group were lower than the control groups evidently. Clinical results were graded as excellent in 72 % of the experimental group and 58% of the control group, respectively. The clinical results of the experimental groups were better than that of control groups. There were no skin flap necrosis, leakage of cerebrospinal fluid and intracranial infection of the experimental groups. Conclusion The decompression procedure by net like skin flap cutdown has significant effects of reduce pressure and could be useful in clinical practice.