无骨桥双额开颅大骨瓣减压术治疗双额脑挫裂伤疗效分析

Therapeutic effects of large bone flap decompression with bilateral frontal craniotomy without bone bridge in the treatment of bilateral frontal cerebral contusion and laceration

目的探讨无骨桥双额开颅大骨瓣减压术治疗双额脑挫裂伤的疗效。方法选取2010年1月至2017年5月双额脑挫裂伤患者70例作为研究对象,按术式不同分为对照组和观察组,每组35例。对照组给予分次双侧去大骨瓣减压术,观察组给予冠状切口无骨桥双额开颅大骨瓣减压术。比较术后第3天、第7天颅内压水平;2组术后第14天的GCS评分;比较治疗1个月时清醒人数及清醒时间;随访6个月,比较2组预后情况。结果2组术后第3天、第7天,观察组颅内压均低于对照组,差异有统计学意义(P<0.05);2组术后第14天的GCS评分,观察组GCS评分高于对照组(P<0.05);观察组治疗方案的清醒人数多于对照组,清醒时间明显少于对照组,差异有统计学意义(P<0.05);观察组随访6个月预后情况优于对照组,差异有统计学意义(P<0.05)。结论无骨桥双额开颅大骨瓣减压术治疗双额脑挫裂伤,可降低颅内压,改善预后。

Objective To evaluate the therapeutic effects of large bone flap decompression with bilateral frontal craniotomy without bone bridge in the treatment of bilateral frontal cerebral contusion and laceration.Methods Seventy patients with bilateral frontal cerebral contusion and laceration from January 2010 to May 2017 were selected as the study subjects.They were divided into control group and observation group according to different surgical procedures,with 35 cases in each group.The control group was given bilateral decompression of the large bone flap,while the observation group was given coronal incision for large bone flap decompression with bilateral frontal craniotomy without bone bridge.The intracranial pressure(ICP)level was compared on the 3rd day and the 7th day after operation.The GCS scores on the 14th day after surgery were compared.The number of patients regaining consciousness and the time of regaining consciousness were compared at 1 month after treatment,and the prognosis of the two groups was compared at 6-month follow-up.Results On the 3rd and 7th day after operation,ICP of the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05).The GCS score on the 14th day after operation was higher in the observation group than in the control group(P<0.05).The number of patients regaining consciousness in the observation group was higher than that in the control group,and the time of regaining consciousness was significantly less than that in the control group.The difference was statistically significant(P<0.05).The prognosis at 6-month follow-up in the observation group was better than that of the control group,and the difference was statistically significant(P<0.05).Conclusion In the treatment of bilateral frontal cerebral contusion and laceration,large bone flap decompression with bilateral frontal craniotomy without bone bridge can reduce ICP and improve prognosis.