标准外伤大骨瓣开颅术治疗重型颅脑损伤的临床研究

Clinical study of standard large trauma craniotomy in the treatment of severe traumatic brain injury

目的探讨重型颅脑损伤行标准外伤大骨瓣开颅术的临床疗效。方法将本院2005年1月至2012年12月,重型颅脑损伤患者112例纳入本研究,随机分为观察组和对照组,每组56例,观察组采用标准外伤大骨瓣开颅术,对照组采用常规骨瓣开颅术,对比两组术后疗效,并发症情况以及手术前后神经功能缺损程度评分。结果观察组术后良好率为55.36%,明显高于对照组28.57%,,差异有统计学意义(P<0.05);观察组术后死亡率为8.93%,显著低于对照组14.29%,差异有统计学意义(P<0.05);观察组术后脑切口疝与硬膜下积液发生率明显低于对照组,差异有统计学意义(P<0.05);手术后1个月,观察组神经功能缺损评分为(12.90±2.41),显著低于对照组(21.24±1.99),差异有统计学意义(P<0.05)。结论标准外伤大骨瓣开颅术治疗重型颅脑损伤疗效确切,预后良好,并发症少,值得临床推广应用。

Objective To investigate the clinical effect of standard trauma craniotomy in severe traumatic brain injury. Methods 112 severe craniocerebral injury patients from January 2005 December 2012 were randomly divided into observation group and control group, each 56 pa- tients. In observation group standard trauma craniotomy was performed, and in the control group conventional bone flap craniotomy was used. The two groups＇s curative effect, postoperative complications and degree of neural function defect score before and after surgery were compared. Results The rate of favorable prognosis in observation group was 55.36%, which was significantly higher than 28.57% in control group （P〈0.05）; Postoperative mortality in observation group was 8.93%, and was significantly lower than 14.29% in the control group （P〈0.05）; In observation group, incidence of incision hernia and subdural effusion was significantly lower than the control group （P〈0.05）; 1 month after the surgery, neural function defect score in observation group was 12.90±2.41, significantly lower than 21.24±1.99 in control group （P〈0.05）. Conclusion Standard trauma craniotomy applied in severe traumatic brain injury could improve the prognosis, and reduce complications.