耳后切口去骨瓣减压术治疗重度创伤性脑损伤的研究进展

Research progress in retroauricular incision decompressive hemicraniectomy for the treatment of severe traumatic brain injury

重度创伤性脑损伤(sTBI)是神经外科最常见的危急重症,患者病死率高,预后极差。去骨瓣减压术是sTBI的首选治疗方法。去骨瓣减压术一般选择反问号切口,也有部分学者建议使用三叶草切口及Kempe切口。以上切口尽管疗效显著,但术后脑脊液漏、切口愈合不良、皮瓣缺血坏死等并发症发生率较高,且不同切口之间的优势及不足尚不明确。因此,有学者提出耳后切口去骨瓣减压术治疗sTBI,该切口通过新型皮瓣保留血液供应,可提供更好的减压效果并降低切口相关并发症。笔者针对耳后切口方法、适应证及其与其他切口比较的优缺点进行综述,为sTBI患者去骨瓣减压术选择切口提供理论依据。

Severe traumatic brain injury(sTBI)as the most common emergency severe syndrome in neurosurgery has a high mortality and poor prognosis.Decompressive craniectomy is the first treatment choice for sTBI.The reverse question mark incision was usually adopted in decompressive craniectomy,but some scholars also suggest using the n-type incision and Kempe incision.Although the curative effect is remarkable when using the above incisions,the incidence of postoperative complications is high,such as cerebrospinal fluid leakage,poor wound healing and flap ischemic necrosis.Moreover,the advantages and disadvantages of different incisions are not clear.Therefore,some scholars proposed retroauricular incision decompressive craniectomy for sTBI patients because this incision that retains blood supply through a new flap can provide better decompression effect and reduce incision-related complications.The authors review the research progress in retroauricular incision in aspects of the methods,indications and its advantages and disadvantages in constrast with other incisions,so as to provide a theoretical basis for the selection of incision for decompressive craniectomy in sTBI patients.