颅脑创伤术中急性脑膨出改良过渡性关颅方法的初步探讨

Preliminary discussion of improved transitional skull closing method in treatment of acute encephalocele in craniocerebral trauma surgery

目的研究颅脑创伤实施手术过程中出现急性脑膨出后采取改良过渡性关颅方法的临床效果。方法选择我院2004年5月-2014年5月间颅脑创伤后出现急性脑膨出的186例颅脑创伤患者，根据关颅手术方法不同将其分为两组，对照组62例患者采取传统关颅手术方法，观察组124例患者采取改良过渡性关颅方法暂时性关闭颅腔同时再次进行CT复查，比较两组患者切除脑叶内减压的发生率及预后效果。结果通过对两组患者进行比较，观察组患者切除脑叶内减压发生率明显比对照组低，差异有统计学意义（P〈0．01）；观察组患者预后效果明显优于对照组，差异有统计学意义（P〈0．05）。结论颅脑创伤术中急性脑膨出运用改良过渡性关颅方法治疗，之后再进行cT复查，依据cT检查结果进行正确处理是改善患者预后的关键，改良过渡性关颅方法有助于降低二次脑疝时间，缩短二次手术间隔，对脑组织进行更好的保护。

Objective To study the clinical effects of the improved transitional skull closing method on the acute en- cephalocele occurring in craniocerebral trauma surgery. Methods A total of 186 patients with craniocerebral trauma who had acute encephalocele after the craniocerebral trauma in our hospital from May 2004 to May 2014 were selected and divided into two groups according to the skull closing method. The control group, consisting of 62 patients, was giv- en the traditional skull closing surgical method, and the observation group, consisting of 124 patients, was given the im- proved transitional skull closing method to close the skull temporarily and CT reexamination at the same time. The in- cidences of lobe excision internal decompression and the prognosis effects of the two groups were observed. Results Comparison of the two groups showed that the observation group was significantly lower than the control group in the incidence of lobe excision internal decompression, with statistically significant difference between the two groups （P〈 0.01）; the observation group was significantly better than the control group in the prognosis effect, with statistically sig- nificant difference between the two groups （P〈O.05）. Conclusion The application of improved transitional skull closing method in the treatment of acute encephalocele occurring in craniocerebral trauma surgery and subsequent CT reexami- nation, and proper treatment based on the CT examination results are the key to improving the patients＇ prognosis. The improved transitional skull closing method is conducive to reducing the secondary herniation time, shortening the sec- ond surgery interval and providing better protection for brain tissue.