标准外伤大骨瓣减压术治疗重型颅脑损伤脑疝患者疗效分析

Effects of standard large trauma craniotomy for traumatic brain injure patient with herniation

目的比较标准外伤大骨瓣与常规颞顶瓣开颅术在治疗重型颅脑损伤脑疝形成患者的效果。方法选取2001年1月至2004年6月收治的重型颅脑损伤脑疝形成患者78例行常规颞顶瓣开颅术为常规骨瓣组；选取2010年1月至2012年1月收治的重型颅脑损伤脑疝形成患者153例行标准外伤大骨瓣减压术为标准大骨瓣组。临床结果进行对比分析，6—12个月后，采用格拉斯哥预后评分（GOS）评定治疗效果。结果随访6—12个月后，标准大骨瓣组患者恢复良好／中度残疾29例，重度残疾／植物生存70例，死亡54例。常规骨瓣组患者恢复良好／中度残疾12例，重度残疾／植物生存23例，死亡43例。结论标准外伤大骨瓣减压术是治疗重型颅脑损伤脑疝形成的有效方法，其减压彻底，能明显降低死亡率，减轻颅脑损伤后遗症，提高患者生存质量。

Objective To explore the effects of standard large trauma craniotomy and conventional temporoparietal cranioto- my group in the treatment of severe traumatic brain injury patient with herniation. Methods Clinical outcomes were com- pared between 78 patients with severe traumatic brain injury patient with herniation admitted from January 2001 to June 2004 （conventional craniotomy group） and 153 more recently （from January 2010 to January 2012） admitted patients with severe traumatic brain injury（ standard large trauma craniotomy group）, using the Glasgow Outcome Scale （GOS） to assess the therapeutic effects over 6-12 months of follow-up. Results Over 6-12 months of follow-up, among patients in the stand- ard large trauma craniotomy group ,29 cases had good recovery/moderate disability ,70 cases had severe disability/vegetative state, and 54 cases were dead;among patients in the conventional craniotomy group, 12 cases had good recovery/moderate disability,23 cases had severe disability/vegetative state,and 43 cases were dead. Conclusion Standard large trauma cra- niotomy is effective for treating severe traumatic brain injury as it could provide complete decompression, significantly reduce the death rate ,alleviate the sequelae of craniocerebral injury,and improve patients quality of life.