两种不同手术方式治疗外伤性中央型脑疝临床疗效分析

目的探讨外伤性中央型脑疝患者手术治疗方式。方法回顾性分析2006年1月至2012年1月60例外伤性中央型脑疝患者的临床资料，观察组30例应用单侧骨窗开颅大脑镰切开手术治疗，对照组30例应用双侧骨瓣开颅手术治疗，比较两组患者手术时间、术中输血量、住院时间、术后3个月精神障碍和语言障碍的发生率，并于术后6个月比较两组患者临床疗效。结果观察组手术时间、术中输血量及住院时间均少于对照组，术后3个月精神障碍和语言障碍的发生率均低于对照组，差异均有统计学意义；术后6个月观察组预后良好22例（73．3％），对照组17例（50．6％）（Х^2=1．1422，P=0．2790），差异无统计学意义。结论单侧骨窗开颅大脑镰切开治疗外伤性中央型脑疝创伤小、疗效显著，能最大程度保留额叶功能，可作为外伤性中央型脑疝优选的手术方案。

Objective To investigate surgical approaches for patients with traumatic central brain herniation. Methods The clinical data of 60 patients with traumatic central cerebral hernia treated in our hospital from January, 2006 to January, 2012, were analyzed retrospectively.30 cases in the observation group were treated with the surgical approach of unilateral bone window craniotomy cerebral falx incision, and 30 cases in the control group were treated with the surgical approach of bilateral bone flap craniotomy, the operation time, blood transfusion volume during operatin, length of hospital stay, the rate of mental disorders and language obstacles 3 months after operation, and the clinical curative effect 6 months after operation were compared. Results The operation time, blood transfusion, length of hospital stay of the observation group were less than that of the control group, and the rate of mental disorders and language obstacles 3 months after operation were lower than that of the control group, the difference was statistically significant; 22 cases （73.3%） were good recovery in the observation group and 20 cases （67.7%） in the control group 6 months after operation （ Х^ 2=2.4107, P=0.1205 ） ,there was no significant difference. Conclusion Is Treating with unilateral bone window craniotomy cerebral falx incision has minimalized trauma, significant effect and retention of frontal lobe function to the maximum extent for traumatic central brain herniation n, making it the preferred operation scheme on traumatic central brain herniation.