颅脑创伤术中急性脑膨出改良过渡性关颅方法的初步探讨

Preliminary study on the modified scalp closure method using in acute intraoperative encephalocele

目的 探讨颅脑创伤术中出现急性脑膨出后合理的处理方法。方法回顾性分析2005年1月至2013年2月93例术中出现急性脑膨出的颅脑创伤病例资料，其中62例采用了改良过渡性关颅方法暂时性闭合颅腔并复查CT后再次手术，比较改良过渡性关颅方法组及传统关颅方法组在切除脑叶内减压的发生率以及预后的差异。结果改良过渡性关颅方法组切除脑叶内减压发生率明显少于传统关颅方法组（P〈0．01）。预后差异有统计学意义（P〈0．05）。结论 使用改良过渡性关颅后复查CT，根椐术中CT检查结果合理处理是改善颅脑创伤术中急性脑膨出患者预后的关键，改良过渡性关颅方法有利于减少二次脑疝时间，缩短二次手术间隔以及更好的保护脑组织。

Objective To investigate the suitable management on acute intraoperative encephalocele in head injury patients. Methods 93 cases with acute intraoperative encephalocele in craniocerebral injury from Jan 2005 to Feb 2013 were analyzed retrospectively. The incidence of lobe resection was analyzed and the outcomes after 3 months were assessed by using Gllasgow outcome score （GOS） among 62 patients treated by using the modified scalp closure method and 31 patients treated by the traditional closure method. Results The incidence of lobe resection was significantly reduced by using modified scalp closure method compared with the traditional method after operation （ P 〈 O. 01 ）. There was significant difference in GOS after 3 months between 2 groups（ P 〈0. 05）. Conclusions According to intraoperative findings of CT, the reasonable treatment was the key factor to improve the outcomes of the patients of acute traumatic intraoperative encephalocele. Using modified scalp closure method could reduce the time of the secondary cerebral hernia, shorten interval of twice operation and protect cerebral tissues better.