双额去骨瓣减压术治疗双侧额叶挫裂伤致中央型脑疝的临床报告

Effect of bilateral decompressive craniectomy in the treatment of double frontal brain contusion complicated with central brain herniation

目的探讨针对双侧额叶挫裂伤致中央型脑疝采用双额去骨瓣减压术的疗效。方法选择解放军第九六〇医院神经外科自2010年7月至2016年12月收治的65例采用双额去骨瓣减压术治疗双侧额叶挫裂伤致中央型脑疝患者为研究对象,评估手术效果及预后。结果65例患者术后随访6个月至1年,采用GOS评分评估预后:预后良好(4~5分)20例;预后不良:2分13例,3分17例;死亡(1分)15例。其中GOS评分2~3分的30例患者术后长期随访(至少3年)显示,其GOS评分改善不明显。结论双侧额叶挫裂伤病情发展快,易导致中央型脑疝发生,双额去骨瓣减压术是治疗中央型脑疝患者的有效手段。

Objective To investigate the effect of bilateral frontal decompressive craniectomy in the treatment of central herniation caused by bilateral frontal lobe contusion and laceration.Methods From July 2010 to December 2016,65 patients with central herniation caused by bilateral frontal lobe contusion and laceration were treated with bilateral frontal decompression.The operative effect and prognosis were evaluated.Results The GOS prognostic score from 6 months to 1 year after operation was 4-5 in 20 cases,3 in 17 cases,2 in 13 cases and 1 in 15 cases,with a total of 30 cases having poor prognosis.Long-term follow-up(at least 3 years)of 30 patients with GOS score of 2-3 showed that GOS had little improvement in 3 years after operation.Conclusion Bilateral frontal lobe contusion and laceration develops rapidly,which can easily lead to central herniation.Decompression of bilateral frontal bone flap is an effective method for the treatment of central herniation.