标准去骨瓣减压术在创伤性颅脑损伤治疗中的应用

Application of standard decompressive craniectomy in the treatment of traumatic brain injury

创伤性颅脑损伤由于致残率和病死率高,一直受到国内外神经外科医师的重点关注。各种致伤机制引起的脑挫伤、颅内血肿,是创伤性颅脑损伤急性期颅内压升高的主要原因,标准去骨瓣减压术作为一种经典术式,常常与颅内血肿清除术、脑清创术、内减压术一起,成为创伤性颅脑损伤急性期的主要手术治疗方法,挽救了许多重型颅脑损伤患者的生命,该术式的重要地位至今无可替代。在长期的临床实践中,经过神经外科一线医师及神经科学学者的不懈努力,对于标准去骨瓣减压术的细节、规范及预后的关系作了大量的研究,以期更好地规范创伤性颅脑损伤的治疗,降低重型颅脑损伤患者的病死率和致残率。本文通过查阅以往相关文献,系统性地分析了颅内高压的病理生理机制及标准去骨瓣减压术的机制、发展史、手术方式、适应证及禁忌证、预后及展望等,希望能够对今后的临床工作有一定的指导建议。

Traumatic craniocerebral injury has been paid close attention by neurosurgeons at home and abroad due to its high morbidity and mortality. Cerebral contusion and intracranial hematoma caused by various injury mechanisms are the main causes of increased intracranial pressure in the acute stage of traumatic brain injury. As a classic surgical method, standard decompressive craniotomy, often together with intracranial hematoma evacuation, brain debridement and internal decompression, has become the main surgical treatment in the acute stage of traumatic brain injury, saving the lives of many patients with severe cerebral injury, the importance of this procedure is irreplaceable. In long-term clinical practice, through the unremitting efforts of first-line neurosurgeons and neuroscientists, a large number of studies have been conducted on the relationship between the details, norms and prognosis of craniotomy, so as to better regulate the treatment of traumatic brain injury and reduce the death and disability rate of patients with severe brain injury. This article systematically reviews and analyzes the pathophysiological mechanism of intracranial hypertension and the mechanism, development history, surgical methods, indications and contraindications, prognosis and prospects of the intracranial hypertension. Through this article, the author hope to have some guidance and suggestions for future clinical work.