骨窗加压包扎防治去骨瓣减压术后并发硬膜下积液的疗效分析

The curative effect analysis of subdural effusion treated with bandage secondary to decompressive craniectomy performed in patients with traumatic brain injury

目的观察颅脑损伤去骨瓣减压术后行骨窗加压包扎预防和治疗硬膜下积液的临床疗效。方法选取荆州市第二人民医院神经外科自2009年9月至2015年4月55例颅脑损伤行去骨瓣减压术病例随机分为骨窗加压包扎组(n=26)和常规组(n=29),两组术后均行常规治疗,加压包扎组自术后行绑带骨窗加压包扎1个月,两组定期复查头颅CT,对出现硬膜下积液者及时骨窗加压包扎,对两组患者硬膜下积液的发生率,出现硬膜下积液的时间和术后GOS评分进行比较分析,观察硬膜下积液患者行骨窗包扎干预的疗效。结果骨窗加压包扎组硬膜下积液发生率为7.7%(2/26)明显低于常规组27.6%(8/29),出现硬膜下积液时间为术后评均(38.5±3.7)d明显长于常规组(13±2.9)d,两组比较差异有统计学意义(P<0.05),骨窗加压包扎组GOS评分>3分例数18例(69.2%),常规组为21例(72.4%),两组差异无统计学意义(P>0.05)。10例硬膜下积液病例,发现积液后行骨窗加压包扎干预平均23.9d后积液均吸收,无需手术病例。结论骨窗加压包扎可明显降低颅脑损伤去骨瓣减压术后硬膜下积液的发生率,对术后硬膜积液有很好的预防和治疗作用,该方法简单易行,安全有效,值得临床推广应用。

Objective To observe the curative effect of subdural effusion treated and prevented with bandage secondary to decompressive craniectomy performed in patients with traumatic brain injury.Method 55 cases of traumatic brain injury were undergone decompressive craniectomy from September2009 to April 2015 in department of neurosurgery of the second people ＇s hospital of Jingzhou, and those cases were randomly divided into bone window compression bandage group（n=26） and normal group（n=29）.Analysis the difference of the incidence of subdural effusion, the occurrence time and postoperative GOS score between two groups. And observation the curative effective of subdural effusion treated with bone window compressive bandage. Results The incidence of subdural effusion post decompressive craniectomy is 7.7%（2/26） in bandage group, 27.6%（8/29） in normal group, the average appear time of subdural effusion post decompressive craniectomy in bandage group（38.5 ±3.7） d is longer than normal group（13±2.9） d, there are significant differences between two groups（P〈0.05）. The number of GOS score 3 was 18（69.2%） in bandage group, 21（73.2%） in normal group, there is no significant difference between two groups（P〈0.05）. After average 23.9 d bandage treatment, the subdural effusion of 10 cases were absorbed disappear, there was no case needed operation. Conclusion Bone window compression bandage after decompressive craniectomy performed in patients with traumatic brain injury can obviously reduce the incidence of subdural effusion, and it played an import role in preventing and treating the subdural effusion. This method is simple, safe, and effective, and it is worthy of clinical application.