双额冠状切口大骨瓣开颅术治疗双额叶脑挫裂伤的疗效及对预后的影响

The effect of large trauma craniotomy with bilateral frontal coronal incision on the efficacy and prognosis of patients with contusion and laceration of bilateral frontal lobes

目的探讨双额冠状切口大骨瓣开颅术治疗双额叶脑挫裂伤的疗效。方法回顾性分析行双侧去骨瓣减压手术治疗双额叶脑挫裂伤患者68例，其中36例行双额冠状切口大骨瓣开颅术（观察组），32例行分次双侧去骨瓣减压术（对照组），观察并比较两组患者的预后情况。术后6个月随访采用格拉斯哥预后量表（GOS）评分评定疗效。结果观察组预后良好23例（63．89％，23／36），预后不良8例（22．22％，8，36），死亡5例（13．89％，5／36）；对照组预后良好11例（34．38％，11／32），预后不良9例（28．12％，9／32），死亡12例（37．50％，12／32），两组预后良好率和病死率比较差异有统计学意义（P〈0．05）。结论双额冠状切口大骨瓣开颅术能有效解除或减轻双额叶脑挫裂伤患者颅内高压，改善患者的预后，并降低病死率。

Objective To explore the efficacy of large trauma craniotomy with bilateral frontal coronal incision in treating contusion and laceration of bilateral frontal lobes. Methods The clinical data of 68 patients with contusion and laceration of bilateral frontal lobes who were treated with bilateral decompressive craniectomy were analyzed retrospectively. There were 36 cases（observation group ） treated with large trauma craniotomy with bilateral frontal coronal incision and 32 cases （control group） given bilateral decompressive craniectomy by stages. The prognosis of two groups were observed and compared. The prognosis was evaluated at 6 months after surgery by Glasgow outcome scale （GOS） score. Results There were 23 eases （63.89% ,23/36） who got good recovery,8 cases （22.22% ,8/36） with poor prognosis and 5 dead cases（ 13.89%, 5/36） in observation group. There were 11 cases （ 34.38%, 11/32） who got good recovery, 9 cases （28.12%, 9/32） with poor prognosis and 12 dead cases （37.50%, 12/32） in control group. The rate of goed recovery and moltality between two groups had significant differences （P 〈 0.05 ）. Conclusions The large trauma craniotomy with bilateral frontal coronal incision can significantly relieve or ease intracranial hypertension of patients with contusion and laceration of bilateral frontal lobes. And it can improve the prognosis and decrease the mortality.