标准大骨瓣减压术与传统骨瓣减压术治疗重型颅脑损伤的对比分析

Comparative analysis of the standard large trauma craniotomy decompression and the traditional craniotomy decom-pression for the treatment of severe craniocerebral trauma

目的对比分析标准大骨瓣减压术与传统骨瓣减压术治疗重型颅脑损伤的并发症及疗效。方法将102例重型颅脑损伤患者分为两组,治疗组52例采用标准大骨瓣减压术治疗;对照组50例采用传统骨瓣减压术治疗。通过对术后并发症及术后12个月的GOS评分的分析比较,来评估两种手术方法的治疗效果。结果治疗组的恢复良好率为57.6%、死亡率为11.53%;对照组的恢复良好率为18%、死亡率为38%,两组比较差异有统计学意义(P<0.05)。在并发症方面,治疗组的脑膨出发生率为5.67%,外伤性脑梗死发生率为3.84%;对照组的发生率分别为22%和16%,与对照组相比差异有统计学意义(P<0.05)。治疗组的迟发性颅内血肿、癫痫、颅内感染、脑积水的发生率与对照组比较差异无统计学意义(P>0.05)。结论标准大骨瓣减压术具有手术视野相对开阔、减压范围广泛、副损伤小、扩大颅腔容积更为有效等优点,可以改善预后,降低死亡率。

Objective To analyze the complication and curative effect of severe craniocerebral trauma respectively treated by standard large trauma craniotomy and traditional decompression. Methods 102 patients with severe craniocerebral trauma were divided into two groups, 52 cases in the treatment group adopted the standard large trauma craniotomy treatment, 50 cases in the control group adopted the traditional craniotomy decompression therapy. Evaluated the effect of two surgical methods by postoperative complications and GOS score analysis at 12 months postoperatively. Results The good recovery rate of treatment group was 57.6%, mortality was 11.53%. Good recovery rate of control group was 18%, mortality was 38%. There were significant differences between the two groups（P〈0.05）. In terms of complications, the incidence of encephalocele in treat-ment group was 5.67%, incidence of traumatic cerebral infarction was 3.84%, the incidence of encephaloocele and traumatic cerebral infarction in control group was 22% and 16% respectively, the difference was statistically significant （P〈0.05）. There were no significant differences in the late-onset intracranial hematoma, epilepsy, intracranial infection, the incidence of hydro-cephalus between the two group （P〉0.05）. Conclusion Standard large trauma craniotomy decompression has relatively open field, decompression range, light deputy injury, can effectively expand the cranial cavity volume, it can improve the prognosis and reduce mortality.