不同手术方式治疗双额叶脑挫裂伤的临床疗效比较

Clinical curative effect of different surgical treatment on double frontal cerebral contusion

目的比较单侧开颅大脑镰切开术与双侧骨窗幵颜术治疗双额叶脑挫裂伤的临床疗效。方法回顾性分析我院神经外科2015年1~12月收治的72例双额叶脑挫裂伤患者的治疗情况,其中32例采用单侧开颅大脑镰切开术(单侧开颅组),40例采用常规双侧骨窗开颅术(双侧开颅组),比较两组患者的手术时间、住院时间及术中输血量,所有患者术后3个月按GOS分级评价预后,术后6个月检查语言和精神障碍发生情况。结果单侧开颅组平均手术时间、平均住院时间和术中平均输血量分别为(109.3±22.8)min、(19.4±2.8)d和(342.6±22.8)m L,均明显少于双侧开颅组的(203.5±37.4)min、(25.7±4.2)d和(605.4±69.7)m L,差异均有统计学意义(P<0.05);术后3个月,单侧开颅组恢复良好率为53.13%(17/32),明显高于双侧开颅组的35.00%(14/40),差异有显著统计学意义(P<0.01)。术后6个月,单侧开颅组语言和精神障碍发生率分别为21.88%(7/32)、12.50%(4/32),明显低于双侧开颅组的45.00%(18/40)、32.50%(13/40),差异均有统计学意义(P<0.05)。结论单侧开颅大脑镰切开术治疗双额叶脑挫裂伤减少手术的二次损伤,缩短手术时间,对提高患者的预后具有积极的作用。

Objective To compare the clinical curative effect of unilateral craniotomy via fronto-cerebral falx incision and bilateral bone window craniotomy in the treatment of double frontal cerebral contusion. Methods The clinical data of 72 patients with double frontal cerebral contusion in the Department of Neurosurgery from Jan. to Dec. 2015 were enrolled in the study, including 32 patients treated with unilateral craniotomy via fronto-cerebral falx incision(unilateral craniotomy group) and 40 patients treated with bilateral bone window craniotomy(bilateral craniotomy group). The operation time, length of hospital stay and the amount of intraoperative blood transfusion were compared between the two groups. Prognosis was evaluated at postoperative 3 months according to Glasgow Outcome Scale(GOS), and language and mental disorders were checked six months after operation. Results The operation time, length of hospital stay and the amount of intraoperative blood transfusion in unilateral craniotomy group were(109.3 ± 22.8) min,(19.4 ± 2.8) d,(342.6 ± 22.8) m L, respectively, significantly higher than those in bilateral craniotomy group of(203.5 ± 37.4) min,(25.7±4.2) d,(605.4±69.7) m L(P<0.05). Three months after operation, good recovery rate was 53.13%(17/32) in unilat-eral craniotomy group, significantly higher than that of bilateral craniotomy group of 35.00%(14/40)(P<0.01). Six months after operation, the incidence of language and mental disorders in unilateral craniotomy group were 21.88%(7/32), 12.50%(4/32), significantly lower than those in bilateral craniotomy group of 45.00%(18/40), 32.50%(13/40)(P<0.05).Conclusion In the treatment of double frontal cerebral contusion, unilateral craniotomy via fronto-cerebral falx incision can reduce the secondary damage after surgery, shorten the time of operation, and improve the prognosis of patients.