双侧标准外伤大骨瓣开颅术中自体骨瓣临时回纳脑保护作用的探讨

Cerebral protection by intraoperative temporary restoration of autogenous cranial bone flap

目的探讨双侧标准外伤大骨瓣开颅术中脑组织医源性损伤的发生机制及防范措施，以降低非预期再次手术率及病死率。方法选择97例具双侧标准外伤大骨瓣开颅手术指征的颅脑损伤患者，采用随机数字表法分为回纳组（41例）和常规组（56例）。回纳组术中采用自体骨瓣临时回纳技术，常规组采用双侧标准外伤大骨瓣开颅术。记录两组患者非预期再次手术率及病死率，并进行统计学分析。结果回纳组患者术后非预期再次手术5例（12．20％），其中先手术侧3例（73％），后手术侧2例（49％）；死亡6例（14．6％）。常规组患者术后非预期再次手术17例（30．3％），其中先手术侧14例（25O％），后手术侧3例（5．3％）：死亡19例（33．9％）。回纳组非预期再次手术率及病死率均显著低于常规组，常规组先手术侧再次手术率较同组后手术侧及回纳组的先手术侧明显为高，差异均有统计学意义（均P〈0．05）。结论自体骨瓣术中临时回纳能有效减少术中脑组织医源性损伤，显著降低非预期再次手术率及病死率。

Objective To investigate the cerebral protective effect of intraoperative temporary restoration of autogenous cranial bone flap in bilateral decompressive craniectomy. Methods Ninety seven patients with indication of bilateral decompressive craniectomy were divided into two groups randomly： 41 cases in restored group and 56 in routine group. In restored group the autogenous cranial bone flap was temporarily restored during the operation, and in routine group the bilateral decom- pressive craniectomy was undertaken. The unexpected reoperation rate and case fatality rate were analyzed and compared between two groups. Results The outcomes of patients in restored group were： 5 underwent unexpected reoperation （12.20%）, 3 in prior lateral （7.3%） and 2 in posterior lateral （4.9%）; 6 deaths （14.6%）. The outcomes of patients in routine group were： 17 underwent unexpected reoperation （30.3%）, 14 in prior lateral （25.0%） and 3 in posterior lateral （5.3%）; 19 deaths （33.9%）. The unexpected reoperation rate and case fatality rate in restored group were significantly lower than those in routine group （P〈0.05）. Prior lateral of routine group had higher unexpected reoperation rate than that of posterior lateral （P〈0.05）. Conclusion Intraoperative temporary restoration of autogenous cranial bone flap can effectively reduce iatrogenic injury of cerebral tissuesignificantly, and reduce unexpected reoperation rate and case fatality rate in bilateral decompressive craniectomy.