损伤控制性理论在合并颌面部多发粉碎性骨折的颅脑损伤中的应用

Clinical application of damage control theory in treatment of craniocerebral injury with multiple maxillofacial comminuted fracture

目的探讨应用损伤控制性理论(damage control theory,DCT)来治疗合并颌面部多发粉碎性骨折的颅脑损伤患者的疗效。方法回顾性分析自2014年1月至2016年10月云南省第一人民医院神经外科经DCT指导治疗的合并颌面部多发粉碎性骨折的急性颅脑损伤患者23例,损伤控制性行开颅手术,待病情稳定后行确定性手术,统计其颅内感染、脑脊液漏、癫痫发作的发生情况,以及患者是否及时转入头颈外科行下一步治疗等。结果 23例患者均平稳度过急性期,2周内转至头颈外科行下一步处理,无临床死亡病例,颅内感染3例,脑脊液漏4例,无伤口愈合不良患者,无早期癫痫发生病例。结论合并颌面部多发粉碎性骨折的急性颅脑损伤患者,采用DCT指导治疗,能明显减少继发性损伤,提高生活质量,临床疗效良好。

Objective To discuss the efficiency of craniocerebral injury with multiple maxillofacial comminuted fracture treated by damage control theory. Methods Twenty-three craniocerebral injury with multiple maxillofacial comminuted fracture patients treated by damage control theory were enrolled from January 2014 to October 2016 in Department of Neurosurgery, the First People＇ s Hospital for the retrospective analysis, controlled doing the deterministic craniocerebral operation after the condition stable, then evaluated the clinical effect, such as the occurrence of intracranial infection, CSF leak and the epilepsy, and whether they transferred to the Department of Ear, Nose, Throat and Head and Neck Surgery in a timely manner. Results All the 23 patients passed through the acute phase steadily and transferred to the Department of Ear, Nose, Throat and Head and Neck Surgery, there is no deaths report, 3 patients suffered with intracranial infection, 4 patients occurred temporal CSF leak, no poor wound healing sick and none early seizures. Conclusion Treatment using the damage control theory has a good clinical effect on crauiocerebral injury patients with multiple maxillofacial comminuted fracture, can decrease the secondary injury and improve the patient quality of life effectively.