重型特重型颅脑伤脑疝时应用天幕裂孔切开术的临床研究(附89例报告)

Clinical study of tentorium cerebelli hiatus incision in treatment of severe and most severe brain injury complicated from tentorial herniation (A report of 89 cases)

目的 探索天幕裂孔切开术在救治重型特重型颅脑伤合并颞叶钩回疝的作用。方法 对我科 1994年 7月到 2 0 0 0年 12月间收治的 89例重型特重型颅脑伤合并有颞叶钩回疝继发脑干伤患者在开颅清除血肿去骨瓣的基础上加行天幕裂孔切开术。结果 GCS 3～ 5分 32例 ,6～ 8分 5 7例 ,恢复良好 4 8例 (5 3 9% ) ,中残 13例 (14 6 % ) ,重残 9例 (10 1% ) ,植物生存 7例 (7 8% ) ,死亡 12例 (13 5 % )。结论 天幕裂孔切开术有利于缓解颞叶钩回疝及所致继发性脑干伤 。

Objective To explore the effect of tentorium cerebelli hiatus incision in treatment of severe and most severe brain injury complicated from tentorial herniation. Methods Tentorium cerebelli hiatus incisions were made on the base of intracranial hematoma evacuation and bone flap craniotectomy decompression on 89 patients of severe and most severe brain injury with secondary brain stem injury resulted from tentorial herniation from July 1994 to Dec 2000. Results 32 cases had GCS score 35 and 57 cases GCS 68 48 cases (53 9%) survived well, 13 cases suffered from (14 6%) moderate disability, 9 cases(10 1%) severe deficit, 7 cases (7 8%) vegetative and 12 cases (13 5%) death according to GOS. Conclusions Tentorium cerebelli hiatus incision could take effect on reducing secondary brain stem injury resulted from tentorial herniation and could bring down the disability and mortality of these patients.