扩大标准大骨瓣并部分内减压手术治疗大面积脑梗死临床分析

Clinical study on expanded standard big bone disc and decompression surgery in treatment of large area cerebral infarction

目的通过对比扩大标准大骨瓣并部分内减压手术与传统单纯标准大骨瓣减压手术对大面积脑梗死的治疗效果,探讨扩大标准大骨瓣并部分内减压手术治疗大面积脑梗死的临床应用价值。方法对2007年10月至2011年月收治的经手术治疗的50例大面积脑梗死患者的临床资料进行分析,按手术方法的不同分为研究组(n=26)和对照组(n=24),研究组患者均采用扩大标准大骨瓣并部分内减压手术治疗,对照组患者采用传统单纯标准大骨瓣减压术治疗,根据两组治疗结果对比其疗效。结果治疗观察10个月,根据Jennett-Bondy预后分级,研究组Ⅰ级2例(7.69%),Ⅱ级2例(7.69%),Ⅲ级5例(19.23%),Ⅳ级13例(50%),Ⅴ级4例(15.39%);对照组Ⅰ级2例(8.33%),Ⅱ级5例(20.84%),Ⅲ级6例(25%),Ⅳ级8例(33.33%),Ⅴ级3例(12.5%)。研究组存活患者恢复好(Ⅳ～Ⅴ级)17例,占65.39%,明显高于对照组的11例(45.83%),差异有显著性(P<0.05)。结论应用扩大标准大骨瓣并部分内减压手术治疗大面积脑梗死患者,相较于传统单纯标准大骨瓣减压手术,虽无法明显降低病死率,但可明显提高治愈好转率,改善患者生存质量。

Objective Through the comparison of effectiveness of expanded standard big bone disc and traditional simple decompression surgery with standard big bone disc decompression surgery in treatment of large area cerebral infarction, try to explore the clinical advantages of expanded standard big bone disc and decompression surgery in treatment of large area cerebral infarction. Methods The clinical data of 50 cases of large area cerebral infarction treated by surgery in this hospital during October 2007 to July 2011 were retrospectively analyzed, and they were divided into trial group （n =26） and control group （n =24） according to the procedure of operation, patients in trial group were applied with expanded standard big bone disc and decompression surgery, and patients in control group were treated by traditional simple standard big bone disc decompression surgery and curative effects of treatment between these two groups were compared. Results After follow - up observation for 10 months, the efficacy in trial group according to Jennett - Bondy grading system for prognosis listed as grade I in 2 cases （7.69%）, grade II in 2 cases （7.69%）, grade III in 5 cases （ 19.23% ）, grade IV in 13 cases （50%） and grade V in 4 cases （ 15.39% ）. The efficacy in control group showed as grade I in 2 cases （8.33%） , grade II in 5 cases （20.84%） , grade III in 6 patients （25%）, grade IV in 8 cases （33.33%） and grade V in 3 cases （12.5%）. Among survived patients in trial group, 17 cases （17/26, 65.39% ） got good recovery （with grades IV - V）, these figures were higher than those of control group （ 11/24,45.83% ） （ P 〈 0.05 ）. Conclusion The application of expanded standard big bone disc and large decompression surgery in patients with cerebral infarction is successful, compared with patients by traditional simple standard big bone disc decompression surgery, although it does not obviously decrease the mortality, but it can obviously improve the recovery rate and raise the quality of life of these patients.