标准外伤大骨瓣开颅术与常规骨瓣开颅术治疗重型颅脑损伤临床价值对比研究

Comparative study on the clinical value of standard traumatic craniotomy and conventional craniotomy in the treatment of severe craniocerebral injury

目的探究标准外伤大骨瓣开颅术与常规骨瓣开颅术治疗重型颅脑损伤临床价值,并进行对比研究。方法选取2014年3月至2017年4月本院收治的74例重型颅脑损伤患者作为研究对象,采取随机双盲法将其分为研究组与对照组各37例。对照组患者行常规骨瓣开颅手术治疗,研究组患者行标准外伤大骨瓣开颅术治疗,对比两组患者术前及术后颅内压恢复情况、神经功能评分、患者预后情况及并发症率。结果术后,两组患者颅内压水平、NHISS评分显著下降,且研究组患者下降程度更明显;差异有统计学意义(P<0.05)。研究组患者预后优良率94.59%,显著高于对照组患者预后优良率82.86%,差异具有统计学意义(P<0.05)。研究组患者术后并发症率2.70%,显著低于对照组患者并发症发生率16.22%,差异有统计学意义(χ~2=3.944 6,P=0.047 0)。结论标准外伤大骨瓣开颅术与常规骨瓣开颅术治疗重型颅脑损伤均效果良好,前者术后患者颅内压下降更显著,患者神经功能恢复更佳,且预后良好,并发症率更低。

Objective To explore the clinical value of standard traumatic craniotomy and conventional craniotomy in the treatment of severe craniocerebral injury,and to carry out the comparative study. Methods From March 2014 to April 2017,74 cases of severe craniocerebral injury in our hospital were selected as the research subjects. They were randomly divided into two groups： 37 cases in each group. The patients in the control group were treated with conventional craniotomy,and the patients in the study group were treated with standard large bone flap craniotomy. The recovery of intracranial pressure,neurological function score,prognosis and complication rate were compared between the two groups before and after operation.Results After the operation,the level of intracranial pressure and NHISS score in the two groups decreased significantly,and the degree of decline was more obvious in the study group,and the difference was statistically significant（ P〈0.05）. The good rate of prognosis of the patients in the study group was 94. 59%,which was significantly higher than that of the control group. The good rate of prognosis was 82.86%,and the difference was statistically significant（ P〈0.05）.Postoperative complications in the study group was 2.70%,significantly lower than the control group the incidence of complications was 16.22%,the difference was statistically significant（ χ~2= 3.944 6,P = 0.047 0）.Conclusions Both Standard traumatic craniotomy and conventional craniotomy in treatment of severe craniocerebral injury have good effect. The former has a more significant decrease in intracranial pressure. The recovery of neurological function is better,and the prognosis is good,and the rate of complications is lower.