改良大骨瓣减压术治疗特重型创伤后急性弥漫性脑肿胀

Modified decompression craniotomy for treatment of extremely severe posttraumatic acute diffuse brain swelling

目的探讨改良大骨瓣开颅减压术（modified decompression eraniotomy，MDC）治疗创伤后急性弥漫性脑肿胀（post—traumatic acute diffuse brain swelling，PADBS）的作用。方法回顾性分析48例临床资料，31例采取标准大骨瓣开颅减压术（standard large trauma decompression craniotomy，SDC），17例采取MDC.分析两组临床资料、颅腔代偿容积、术后并发症发生率及6个月后格拉斯哥预后评分（Glasgow outcome scale，GOS）。结果MDC所获得的颅腔容积代偿增加值约占颅腔容积的8．2％。两组术后并发症包括再出血、颅内感染、切口疝、癫痫、切口脑脊液漏和脑积水，组间比较差异均无统计学意义（P〉0．05）。术后6个月GOS评分：预后良好（4—5分）SDC组为13例（42％），MDC组为13例（76％）；预后不良（2～3分）SDC组为13例（42％），MDC组为3例（18％）；SDC组死亡5例（16％），MDC组死亡1例（6％）。MDC组预后优于SDC组（Z=2．318，P〈0．05）。结论对PADBS患者采用MDC，可提高患者治疗效果，改善预后。

Objective To investigate the effect of modified decompression craniotomy （MDC） for treatment of extremely severe post-traumatic acute diffuse brain swelling （ PADBS）. Methods Forty-eight patients with PADBS out of which 31 underwent standard large trauma decompression craniotomy （SDC） and 17 MDC were analyzed retrospectively. Clinical data, cranial capacity compensation, postoperative complications, and Glasgow outcome scale （GOS） 6 months after operation were recorded and compared between the two groups. Results Increased cranial capacity compensatory value accounted for 8.2% of the cranial capacity after MDC. Postoperative complications included rehemorrhage, intracranial infection, incisional hernia, epilepsy, cerebrospinal fluid leakage, and hydrocephalus and no statistical differences were observed between the two groups （ P 〉 0.05 ）. Based on GOS, the outcome was good in 13 patients （42%） , poor in 13 （42%） , with 5 deaths （16%） in SDC group, while the outcome was good in 13 patients （76%）, poor in 3 （18%）, with 1 death （6%） in MDC group. The outcome in MDC group was better than that in SDC group （Z = 2. 318, P 〈 0.05）. Conclusion For patients with PADBS, MDC can improve the outcome and prognosis.