组合切口额颞大骨瓣开颅救治广泛额颞部脑损伤

Combination incisions in frontal-temporal large craniotomy for extensive temporofrontal severe head injury

目的 :探讨组合切口额颞大骨瓣开颅术在救治广泛额颞部脑损伤中的应用。方法 :对 75例经CT扫描诊断的单侧额颞部广泛脑损伤有手术指征的患者随机采用额颞马蹄形切口普通骨瓣开颅 (常规术式 )和组合切口额颞大骨瓣开颅 (组合术式 )。以格拉斯哥预后评分判定疗效 ,结果进行统计学处理。结果 :组合术式组恢复良好率优于常规术式组 (P <0 .0 5 ) ;术中脑膨出发生率较常规术式组有所下降 ,但差异无显著性 (P >0 .0 5 ) ;术后昏迷时间明显缩短 (P <0 .0 5 )。结论 :组合术式额颞大骨瓣开颅切口设计符合美容要求 ,减压充分、合理 ,能有效改善脑循环 。

Objective:To evaluate the effect of combination incisions on frontal temporal large craniotomy for treatment of extensive severe temporofrontal head injury. Methods:Seventy five cases of CT diagnosed unilateral severe temporofrontal head injury were randomd to common frontal temporal craniotomy(routine method,in 35 cases) or large craniotomy with combination incisions(combination method,in 40 cases). The effects were evaluated by Glasgow outcome scale and the results were statistically analyzed.Results:The recovery rate in the group with combination method was higher than that with routine method( P <0.05) and the occurrence of intraoperative encephalocele was decreased in the group with combination method but the difference was not significant( P >0.05).The time of posto perative coma was shorter in the group with combination method than that with routine method( P <0.05).Conclusions:The design of combination incisions coincides with the plastic surgery techniques.The decompression of the large craniotomy is complete and reasonable.As the circulation of brain is improved,the prognosis of patients with extensive temporofrontal severe head injury is much better.