不同开颅术式治疗非对称性双侧额叶挫裂伤的疗效分析

Efficacy analysis of two different craniotomies in the treatment of patients with asymmetric bilateral frontal contusion

目的探讨单侧和双侧不同开颅术式在治疗非对称性双侧额叶挫裂伤的疗效。方法回顾性分析联勤保障部队第九〇〇医院神经外科自2016年2月至2019年2月收治的经手术治疗的非对称性双侧额叶挫裂伤患者的临床资料,根据手术入路不同分为单侧额颞开颅联合大脑镰切开组和双侧额部冠状开颅组,分析2组患者在性别、年龄、术前GCS评分、手术时间、术中出血量、术后颅内感染发生率、3个月GOS评分及额叶额叶功能评定量表(FAB)评分等方面的差异。结果纳入的43例患者中,经单侧额颞开颅者18例,双侧冠状开颅者25例。2组患者的基线资料比较,差异无统计学意义(P>0.05)。单侧开颅组的手术时间和术中出血量较双侧冠状开颅较少,术后3个月的额叶FAB量表评分较双侧冠状开颅者得分高,差异均具有统计学意义(P<0.05);2组患者的术后颅内感染率和3个月GOS评分比较,差异无统计学意义(P>0.05)。结论单侧额颞开颅联合大脑镰切开术不仅具有与双侧冠状开颅相一致的手术疗效,同时还具有创伤小、手术时间短、额叶功能保护好的优点。

Objective To explore the efficacy and advantages of unilateral and bilateral different craniotomies in the treatment of patients with asymmetric bilateral frontal contusion.Methods The clinical data of patients with asymmetric bilateral frontal contusion treated from February 2016 to February 2019 in Neurosurgery Department of the 900th Hospital of Joint Logistics Team were retrospectively analyzed.They were divided into unilateral frontotemporal craniotomy combined with falx cerebral incision group and bilateral coronary craniotomy group according to different surgical approaches.The gender,age,preoperative GCS score,operation time,intraoperative amount of bleeding,postoperative,incidence of intracranial infection,GOS score and frontal assessment battery(FAB)scale at 3 months were analyzed.Results Forty-three patients were enrolled,including 18 cases with unilateral frontotemporal craniotomy,and 25 cases with bilateral coronary craniotomy.Baseline data were compared between the 2 groups with no significant difference(P>0.05).The operative time and intraoperative blood loss of unilateral group were less than those of bilateral group,and the difference was statistically significant(P<0.05).The FAB scores at 3 months in unilateral group were higher than those in bilateral group,the difference was statistically significant(P<0.05).There were no significant differences in postoperative intracranial infection and GOS score at 3 months between the two groups(P>0.05).Conclusion Unilateral frontotemporal craniotomy combined with falx cerebral incision not only has surgical efficacy consistent with bilateral coronary craniotomy,but also has the advantages of less trauma,shorter operation time,better protection of frontal function.