常规与标准外伤大骨瓣开颅减压术对对冲性颅脑外伤病人术中急性脑膨出及近期预后的影响

Compared of the effects of conventional and standard large trauma craniotomy decompression on acute encephalocele and short-term prognosis in patients with contrecoup craniocerebral injury

目的比较常规与标准外伤大骨瓣开颅减压术治疗对冲性颅脑外伤术中急性脑膨出及近期预后。方法对冲性颅脑外伤病人150例,根据手术方法分为常规组和标准组,每组各75例,分别行常规骨瓣开颅减压术与标准外伤大骨瓣开颅减压术。比较两组术中急性脑膨出发生率及近期预后。结果标准组术中急性脑膨出发生率(37.33%)低于常规组(68.00%),术后脑中线恢复率(78.67%)高于常规组(46.67%),术后切口疝发生率(10.67%)低于常规组(65.33%),差异有统计学意义(P<0.05);两组术中死亡率与迟发性血肿发生率比较,差异无统计学意义(P>0.05);标准组术后1周格拉斯哥昏迷评分高于术前(P<0.05),高于常规组(P<0.05);标准组术后3个月格拉斯哥预后评分优于常规组(P<0.05)。结论标准外伤大骨瓣开颅减压术能够降低对冲性颅脑外伤术中急性脑膨出发生率,提高患者近期预后。

Objective To compare the effects of conventional and standard large trauma craniotomy decompression on acute encephalocele and short-term prognosis in patients with contrecoup craniocerebral injury. Methods A total of 150 patients with contrecoup craniocerebral injury were divided into traditional group（ n = 75） and standard group（ n = 75） according to the surgical methods,the conventional craniotomy decompression and the standard large trauma craniotomy decompression were performed respectively. The incidence rate of acute encephalocele and short-term prognosis were compared between the two groups. Results The incidence rates of acute encephalocele（ 37. 33%） and postoperative incisional hernia（ 10. 67%） in the standard group were significantly lower than those in the traditional group（ 68. 00%,65. 33%）,while the incidence rate of postoperative cerebral midline recovery（ 78. 67%） was significantly higher than that in the traditional group（ 46. 67%）,the differences were statistically significant（ P〈0. 05）. There was no significant difference in operative mortality and the incidence of delayed hematoma between the two groups（ P〈0. 05）. One week after surgery,the Glasgow coma score in the standard group was significantly higher than that before surgery,and the score was significantly higher than that in the traditional group,the differences were statistically significant（ P〈0. 05）. Three weeks after surgery,the Glasgow outcome score in the standard group was significantly better than that in the traditional group,the difference was statistically significant（ P〈0. 05）. Conclusion Standard large trauma craniotomy decompression can reduce the incidence of acute encephalocele and improve short-term prognosis.