预见性双侧平衡去骨瓣减压术治疗重型闭合性颅脑损伤75例

Application of predictive decompression via bilaterally balanced removal of bone flap in the treatment of severe closed craniocerebral injury

目的探讨预见性双侧平衡去骨瓣减压术治疗重型闭合性颅脑损伤的临床疗效,为临床治疗提供依据。方法按照随机数字表法将150例重型颅脑损伤患者分为观察组和对照组,每组75例,观察组给予预见性双侧平衡去骨瓣减压术治疗,对照组给予单侧标准大骨瓣减压术治疗,比较两组治疗前后颅内压,急性脑膨出、切口疝发生率、生活质量以及并发症的发生率。结果治疗前两组颅内压比较无统计学意义(P>0.05),术后两组颅内压均显著降低,且观察组低于对照组(P<0.05);观察组急性脑膨出和术后切口疝发生率低于对照组(P<0.05);观察组生存质量高于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论预见性双侧平衡去骨瓣减压术治疗重型闭合性颅脑损伤能有效降低颅内压,提高患者生活质量,降低并发症的发生率。

Objective To study the clinical effect of the treatment of severe closed craniocerebral injury with predicative decompression via bilaterally balanced removal of bone flap,to provide reference for clinical treatment. Methods Totally 150 patients with severe craniocerebral injury were selected and assigned into study group and control group according to the random number table method,75 cases in each group. The study group was treated with predictive decompression via bilaterally balanced removal of bone flap,while the control group was treated with unilateral decompression via removal of standard large bone flap. Intracranial pressure,incidence of acute encephalocele andincision hernia,quality of life and complications were compared between the two groups before and after treatment.Results There was no statistically significant difference in intracranial pressure before treatment（ P〈0.05）,yet after treatment,intracranial pressure was significantly decreased in two groups,which is significantly lower in the study group than the control group（ P〈0.05）. Incidences of acute encephalocele and postoperative incisional herniawere significantly lower in the study group than the control group,the difference of which was statistically significant（ P〈0.05）. Quality of life of the study group was significantly higher than the control group,and the incidence of complications was significantly lower in the study group than the control group,the differences of which were statistically significant（ both P〈0.05）. Conclusions Predictive decompression via bilaterally balanced removal of bone flap for severe closed craniocerebral injury can effectively reduce intracranial pressure,improve the quality of life among patients,and reduce the incidence of complications.