去骨瓣减压术后硬脑膜扩大成形治疗重型颅脑损伤

Expanded duraplasty after decompressive craniotomy for treatment of serious traumatic brain injury

目的:探讨重型颅脑损伤去骨瓣减压术减少术后并发症的手术防治方法。方法:39例重型颅脑损伤患者,中线移位大于0.5 cm者29例。单侧去骨瓣20例,双侧去骨瓣9例。额颞去骨瓣后将硬脑膜做成向额顶和向颞顶掀起的硬膜瓣,关颅时将硬膜瓣与颞肌骨面减张缝合,封闭硬膜腔。结果:术后3 d内CT复查:骨窗后缘处隆起脑组织钝角移行34例,接近或小于直角移行5例。中线复位25例,轻度移位10例,移位大于0.5 cm4例。治疗结果:恢复良好17例,轻残9例,重残3例,植物生存1例,死亡9例,病死率23.1%。未发生常见的脑组织嵌顿、脑表面静脉回流障碍等去骨瓣减压术后并发症。结论:去大骨瓣减压后硬脑膜成形对防止术后脑组织嵌顿,减少脑表面静脉回流障碍等并发症有良好效果。

Objective：To explore the protective methods against postoperative complications after decompressive craniotomy for severe head trauma. Methods： In 39 patients with severe brain injury, midline shift 〉0.5 cm was observed in 29 cases. Frontal and temporal dura flap was elevated after decompressive craniotomy. After operation, the dura was sutured onto the temporal muscle to close the dural cavity. Results： CT scan was performed 3 days after operation. Mild brain shift at the posterior edge of the skull window was found in 34 cases. Obvious shift was found in 5 cases. Midline shift disappeared in 25 cases, mild shift in 10 cases and 〉0.5 cm shift in 4 cases. Clinical outcome., good recovery 17 cases, mild disability 9 cases, severe disability 3 cases and vegetarian life 1 case, death 9 cases. Mortality was 23.1%. Hernia and superfacial vein dysfunction were not found. Conclusion： Expanded duraplasty after decompressive craniotomy is effective against postoperative brain hernia and superfacial vein dysfunction.