改良去骨瓣减压术治疗重型颅脑损伤的临床研究

李勤朴，张民

吉林省通化市中心医院神经外科，吉林通化134000

[摘要]目的探讨重型颅脑损伤患者采取改良去骨瓣减压术的疗效。方法随机选取200例于2010年5月—2015年5月期间该院接收的重度颅脑损伤患者，将其按手术方式的不同分为对照组与实验组，两组分别采用标准外伤大骨瓣减压术和改良去骨瓣减压术，观察两组疗效。结果术后2周，实验组GCS评分为（12.31±2.34）分，对照组为（9.51±1.32）分，实验组GCS评分较对照组明显要高（P<0.05）；同时治疗后实验组恢复良好率为51.0%、死亡率5.0%、重度残疾8%、轻度残疾29%、植物生存7.0%，而对照组分别为32.0%、14.0%、25.0%、10%、19.0%，实验组预后明显优于对照组（P<0.05）；另外实验组术后20例（20.0%）发生并发症，而对照组共39例（39.0%）发生并发症，差异有统计学意义（P<0.05）。结论对重度颅脑损伤患者采取改良大骨瓣减压术，疗效显著，值得推广。

[关键词]重型颅脑损伤；改良去骨板减压术；疗效

[中图分类号]R651.15

[文献标识码]A

[文章编号]1674-0742（2015）10（a）－0011-03

[作者简介]李勤朴(1974-)，男，吉林人，本科，副主任医师，研究方向：颅脑损伤，血管病。

Abstract[]Objective To study the curative effect of improved decompressive craniotomy in the treatment of severe craniocerebral injury.Methods 200 patients with severe craniocerebral injury treated in our hospital from May 2010 to May 2015 were selected and divided into control group and experimental group according to different operation schemes.Two groups respectively adopted the standard large trauma craniotomy and improved decompressive craniotomy.The curative effect of the two groups was observed.Results Two weeks after surgery, the GCS of the experimental was significantly higher than that of the control group [(12.31±2.34) points vs (9.51±1.32) points](P<0.05); at the same time, rate of good recovery, mortality, severe disability, mild disability, and persistent vegetative status was 51.0%, 5.0%, 8%, 29%, 7.0% respectively in the experimental group and 32.0%, 14.0%, 25.0%, 10% and 19.0% respectively in the control group, which showed that the prognosis was significantly better in the experimental group than in the control group with statistical difference (P<0.05).In addition, the complication rate was 20.0% (20 cases) in the experimental group and 39.0% (39 cases) in the control group, and the difference was statistically significant, P<0.05.Conclusion The improved decompressive craniotomy has an obvious effect on the management of severe craniocerebral injury, therefore it is worthy of clinical promotion.

收稿日期：（2015-07-03）

Clinical Study of Improved Decompressive Craniotomy in the Treatment of Severe Craniocerebral Injury

LI Qin-pu, ZHANG Min

Department of Neurosurgery, Tonghua Central Hospital, Tonghua, Jilin Province, 134000 China

[Key words]Severe craniocerebral injury; Improved decompressive craniotomy; Curative effect

重型颅脑损是脑外科常见的一种具有发病急、病情进展快等特点的急危重疾病，该病预后极差，具有较高的致残、致死率，是中青年致死的主要原因，流行病学调查显示，重度颅脑损伤患者伤后6 h的死亡率为40%以上，重残及植物生存分别为16%和8%。标准外伤大骨瓣减压是既往救治重度颅脑损伤的常见术式，该术式有利于解除脑疝对脑干的压迫，清除血肿，迅速降低颅内压，尤其对难治性颅高压的治疗，效果明显，而目前临床对于标准去骨瓣减压术中脑组织的暴露范围、骨瓣的大小、小脑幕及皮肌瓣的处理等方面仍存在一定争议[1]。近年来，该院于2010年5月—2015年5月期间对该术式进行某些方面的改进，用于治疗部分重度颅脑损伤患者，且取得满意效果，现报道如下。……