对冲性硬膜下血肿大骨瓣开颅减压预防急性脑膨出的效果

Prevention of acute encephalorele in large bone flap craniotomy decompresion for contrecoup subdural hematoma

目的探讨对冲性硬膜下血肿行标准外伤大骨瓣开颅减压术预防急性脑膨出的效果。方法回顾性分析2010-05至2015-05本院神经外科收治的86例对冲性颅脑外伤患者,按手术方式分为大骨瓣开颅减压组和常规组,每组各43例,常规组患者实施常规骨瓣开颅减压术,大骨瓣开颅减压组行标准外伤大骨瓣开颅减压术,比较两组治疗效果。结果大骨瓣开颅减压组患者的术中脑膨出率39.53%、术后切口疝发生率11.63%均显著地低于常规组的67.44%、34.88%(P<0.05),大骨瓣开颅减压组患者术后脑中线恢复率72.09%显著地高于常规组的46.51%(P<0.05);两组患者迟发性血肿发生率、术中病死率差异无统计学意义。术后第1、3、7天大骨瓣开颅减压组患者的格拉斯哥昏迷评分(GCS)值显著地高于常规组患者(P<0.05)。根据格拉斯哥预后评分(GOS)评价标准,大骨瓣开颅减压组患者术后6个月的预后效果优于常规组(P<0.05)。结论对冲性硬膜下血肿颅脑外伤患者行标准外伤大骨瓣开颅减压术对于防治术中急性脑膨出具有显著地效果,同时有利于改善患者的近期预后。

Objective To investigate the effect of prevention and treatment of acute encephalocele in patients with contreconp subdural hematomas undergoing standard big bone flap craniotomy decompression. Methods 86 patients with traumatic brain injury undergoing neurosurgery from May 2010 to May 2015 were analyzed retrospectively and randomly divided into study group and conventional group,43 each. The conventional group were treated with conventional bone flap craniotomy,and the study group was treated with standard large bone flap craniotomy,and the effects of the two groups were compared. Results In the study group,intraoperative encephalocele rate was 39. 53%,the incidence of postoperative incisional hernia（ 11. 63%） was significantly lower than in the conventional group（ 67. 44%）,（ 34. 88%）（ P〈0. 05）. In the study group,midline postoperative recovery rate was 72. 09%,significantly higher than in the conventional group（ 46. 51%,P〈0. 05）. In the two groups,delayed hematoma incidence and mortality were not significantly different. GCS score was significantly higher than the value in the postoperative 1,3,7 d conventional group patients（ P〈0. 05）. According to GOS evaluation criteria,prognosis in the study group after six months was better than that in conventional group（ P〈0. 05）. Conclusions Standard largebone flap craniotomy decompression in contrecoup subdural hematoma is markedly effective for prevention and treatment of intraoperative acute encephalocele,and favonrable to improving the patient short term prognosis.