罗雨 吴静 张云 王存祖 张家明

[摘要] 目的 分析顱脑外伤去骨瓣减压术（DC）患者骨瓣面积的大小与预后结果之间的关系，探讨DC对早期存活患者远期疗效的影响。 方法 选取108例颅脑外伤后行DC治疗，且存活≥1周的患者为研究对象，按照术后6个月Glasgow预后结果分级（GOS）将样本分为预后较好组和较差组，比较两组性别，年龄，入院时GCS评分，骨瓣面积，创伤性硬膜外出血，创伤性硬膜下出血，创伤性蛛网膜下腔出血，脑挫裂伤，颅脑损伤范围，瞳孔大小等临床相关因素有无差异。 结果 108例患者中预后较好组83例，较差组25例。单因素分析显示两组的年龄、入院时GCS评分、瞳孔及骨瓣面积差异有统计学意义（P<0.05）。其中，预后较差组的骨瓣面积明显较大（P<0.05）。结论 在颅脑外伤行DC治疗患者中，骨瓣面积是影响预后结果的独立因素，骨瓣面积越大，远期预后结果可能越差。预防性地扩大骨瓣面积，来达到降低颅压以改善预后结果的做法并不可取。

[关键词] 颅脑外伤;去骨瓣减压术;骨瓣面积;远期疗效;预后结果

[中图分类号] R651.15          [文献标识码] A          [文章编号] 1673-9701（2021）35-0013-03

Analysis of correlation between decompressive bone flap area and prognosis of patients with craniocerebral trauma

LUO Yu1   WU Jing2   ZHANG Yun1   WANG Cunzu3   ZHANG Jiaming1

1.Department of Emergency Medicine， Wuxi People′s Hospital Affiliated to Nanjing Medical University， Wuxi   214001， China; 2.Department of Tuberculosis， Yangzhou Third People′s Hospital in Jiangsu Province， Yangzhou   225001， China; 3.Department of Neurosurgery， The Northern Jiangsu People′s Hospital， Yangzhou   225001， China

[Abstract] Objective To analyze the correlation between the area of the bone flap and the prognosis of patients undergoing decompressive craniectomy（DC） for craniocerebral trauma， and to explore the effect of DC on the long-term curative effect of early surviving patients. Methods A total of 108 patients who were treated with DC after craniocerebral trauma and survived for ≥one week were selected as the research objects. According to Glasgow Outcome Scale （GOS） at 6 months after operation， the objects were divided into the better prognosis group and the worse prognosis group. The gender， age， Glasgow coma scale score at admission， bone flap area， traumatic epidural hemorrhage， traumatic subdural hemorrhage， brain contusion and laceration， craniocerebral injury area and pupil size were compared between the two groups. Results Among 108 patients， 83 cases had good prognosis and 25 had poor prognosis. Univariate analysis showed that there were significant differences in age， GCS score at admission， pupil and bone flap area between the two groups （P<0.05）.Among them， the bone flap area in the poor prognosis group was significantly larger （P<0.05）. Conclusion In patients with craniocerebral trauma treated with DC， the area of bone flap is an independent factor affecting the prognosis. The larger the area of bone flap， the worse the long-term prognosis may be. It is not advisable to expand the area of bone flap preventively to reduce intracranial pressure and improve the prognosis.

[Key words] Craniocerebral trauma; Decompressive craniectomy; Bone flap area; Long-term curative effect; Prognostic outcome

去骨瓣减压术（Decompressive craniectomy，DC）是治疗颅脑外伤患者常用的手术方式，作用是扩大颅腔体积，降低颅内压，达到救治危重患者，降低患者致死率、致残率的目的[1-2]。骨瓣面积与减压效果息息相关，一般认为两者间呈正比，所以，临床上神经外科医师往往采取大骨瓣减压的方式[3]。然而，有关骨瓣面积的大小对患者预后的影响，目前还没有相关文献进行深入的研究。理论上，骨瓣面积越大，患者预后可能越好。……