重型颅脑损伤大骨瓣开颅硬脑膜修补的体会

Retrospective study on large trauma craniotomy and dural repair in severe brain damage

目的:总结标准外伤大骨瓣开颅及颅硬脑膜修补方法对重型颅脑损伤治疗的体会。方法:回顾总结54例采用标准外伤大骨瓣开颅术并常规行硬脑膜减张严密缝合(人工硬脑膜补片或自体颞肌筋膜)治疗重型颅脑损伤的过程。结果:术后并发症有颅内再出血、脑嵌顿(骨窗疝)、脑穿通畸形、脑积水、癫痫。无脑脊液漏及感染,无皮下积液。死亡15例,植物生存4例,重残5例,中残8例,良好22例。结论:重型颅脑损伤手术中用人工脑膜补片(主要牛心包膜)或自体颞肌筋膜减张缝合硬脑膜可以明显减少术后并发症的发生,为愈后提供良好的帮助。

Objective To analyze the curative effect of standard large trauma craniotomy and dural repair in the treatment of severe brain damage. Method 54 cases with severe brain damage were treated by big craniotomy with bone flap and dural de-stretching suture （ with artificial dura patch or autologous）temporalis fascia of severe brain damage. Results post-operative complications include Cerebral herniation,Cerebromalacia porencephalia,Hydrocephalus,Rehaemorrhagia,Epilipsy. 15 cases died,4 cases of vegetative state,5 cases of se-vere disability,8 cases of moderate disability,22 cases of good recovery. Conclusion Using artificial dura patch（ mostly bovinepericardi-um）or autologous temporalis fascia in standard large trauma craniotomy can reduce post-operative complications.