探讨改良外伤大骨瓣手术对重型脑外伤的治疗效果与并发症情况

Discussion on the Therapeutic Effect and Complications of Modified Large Bone Flap Surgery for Severe Brain Injury

目的观察在临床治疗重型脑外伤患者中以改良外伤大骨瓣手术进行治疗的效果以及并发症状况。方法将该院神经外科2017年1月—2019年12月诊治的137例重型脑外伤患者作为分析对象,按不同手术方法进行随机采样分组,分成68例对照组,69例研究组。在对重型脑外伤患者的治疗中,对照组行常规大骨瓣术,研究组行改良性外伤大骨瓣手术。对比两组患者术前、术后的GCS评分;对比两种手术的、治疗有效率;比较患者在手术治疗后出现癫痫、切口疝、颅内感染、脑脊液漏等并发症的情况;对比患者经手术治疗后血清中的炎性因子水平。结果术前患者的GCS评分比较,差异无统计学意义(P>0.05)。研究组术后GCS评分为(13.26±1.28)分,高于对照组,差异有统计学意义(t=8.315,P<0.001)。研究组治疗有效率为81.16%,高于对照组,差异有统计学意义(χ^(2)=3.968,P=0.046);研究组并发症的发生率为10.14%,低于对照组,差异有统计学意义(χ^(2)=4.392,P=0.036);研究组hs-CRP(5.94±1.37)mg/L、TNF-α(12.33±4.18)ng/L、IL-6(8.17±2.17)ng/L,均优于对照组,差异有统计学意义(t=15.769、9.863、11.434,P<0.001)。结论在重型脑外伤的治疗中,改良外伤大骨瓣手术的应用对患者GCS评分具有改善作用,且能有效减少并发症风险并提高治疗效果。

Objective To observe the effect and complication of modified large trauma bone flap surgery in the treatment of patients with severe head injury.Methods 137 patients with severe brain injury diagnosed and treated in the hospital's neurosurgery department from January 2017 to December 2019 were analyzed.Random sampling and grouping according to different surgical methods were divided into 68 control groups and 69 study groups.In the treatment of patients with severe brain injury,the control group underwent conventional large bone flap surgery,and the study group underwent modified large trauma bone flap surgery.Compared the GCS scores of the two groups before and after surgery;compared and observed the mortality and treatment efficiency of the two types of surgery;compared the complications of epilepsy,incisional hernia,intracranial infection,and cerebrospinal fluid leakage after surgery;compared the serum levels of inflammatory factors in patients after surgical treatment.Results There was no significant difference in preoperative GCS score(P>0.05).The postoperative GCS score of the study group was(13.26±1.28)points,which was higher than that of the control group,the difference was statistically significant(t=8.315,P<0.001).The therapeutic effective rate of the study group was 81.16%,which was higher than that of the control group,and the difference was statistically significant(χ^(2)=3.968,P=0.046);the incidence of complications in the study group was 10.14%,which was lower than that in the control group,the difference was statistically significant(χ^(2)=4.392,P=0.036);hs-CRP(5.94±1.37)mg/L,TNF-α(12.33±4.18)ng/L,IL-6(8.17±2.17)ng/L,in the study group were better than those in the control group,the difference was statistically significant(t=15.769,9.863,11.434,P<0.001).Conclusion In the treatment of severe brain trauma,the modified large trauma bone flap surgery is of good value,clinical efficacy,patients with GCS score improvement,and can effectively reduce the risk of complications.