李波

[摘要] 目的 分析額颞对冲性颅脑损伤（HI）行扩大翼点入路手术的价值与预后情况。 方法 选择2016年1月至2020年1月间来院治疗的132例HI患者。以随机法为基准，A组67例，手术入路选用扩大翼点法，B组65例，直接选择开颅手术。对比整体化疗效。 结果 A组的良好痊愈率为61.19%，高于B组的43.08%;A组的死亡率为2.99%，低于B组的15.38%，两组比较，差异有统计学意义（P<0.05）。A组的不良事件发生率为4.48%，低于B组的16.92%，两组比较，差异有统计学意义（P<0.05）。术后各个时间点，A组的颅内压值低于B组，两组比较，差异有统计学意义（P<0.05）。术后次日，A组的患者状态评分均高于B组（P<0.05）。 结论 为HI患者实行扩大翼点入路形式的手术治疗可改善预后，而且能够最大化减少不良事件，降低患者的颅内压，疗效理想。

[关键词] 扩大翼点入路手术;额颞对冲性颅脑损伤;预后;不良事件;颅内压

[中图分类号] R651.15          [文献标识码] B          [文章编号] 1673-9701（2021）11-0052-03

The effect of extended pterional approach operation in treatment of frontotemporal contrecoup craniocerebral injury and the improvement of prognosis

LI Bo

Department of Neurosurgery， Heze Peony People's Hospital in Shandong Province， Heze   274000， China

[Abstract] Objective To analyze the value and prognosis of the extended pterional approach operation for frontotemporal contradictory craniocerebral injury（HI）. Methods A total of 132 patients with HI（frontotemporal contrecoup） admitted in the hospital from January 2016 to January 2020 were selected for the study objects and were grouped according to the random method. The group A（67 cases） used the extended pterion operation approach， and the group B selected direct craniotomy. The overall efficacy was compared. Results The excellent cure rate of group A was 61.19%， which was higher than 43.08% of group B. The mortality rate of group A was 2.99%， which was lower than 15.38% of group B. The difference between the two groups was statistically significant（P<0.05）. The probability of adverse events in group A was 4.48%， which was lower than 16.92% in group B. The difference between the two groups was statistically significant（P<0.05）. At various time points after the operation， the intracranial pressure value of group A was lower than that of group B， and the difference between the two groups was statistically significant（P<0.05）. On the next day after the operation， the patient status scores in group A were higher than those in group B（P<0.05）. Conclusion Extended pterional approach operation for patients with HI can improve the prognosis， maximize the reduction of adverse events， and reduce the patient's intracranial pressure， which has an ideal effect.

[Key words] Extended pterional approach operation; Frontotemporal contrecoup craniocerebral injury; Prognosis; Adverse events; Intracranial pressure

额颞对冲伤的致伤原因是脑组织在外力因素下，前中颅窝底部位的骨嵴明显凸起，且脑部结构或颅腔血管受暴力因素影响会发生移动变化，从而使额颞部脑皮质出现严重挫伤[1]。其高发部位在额颞顶面，常合并血肿，是神经外科的频发性疾病。患者的症状为呕吐、头痛与意识不清，经相关体征与CT等综合性诊断后可以明确检出。其基础疗法是手术治疗，传统开颅术难以高效治疗合并脑疝患者，其病灶暴露程度有限，而且减压效果欠佳[2]。而翼点入路能够完全暴露病灶，经颅内的大量瘀血及时清除，解除颅内血肿表现，可显著维持脑功能，降低患者的残疾风险。本研究选取2016年1月至2020年1月间来院治疗的132例额颞对冲性颅脑损伤（Head injury，HI）患者，用于分析扩大翼点入路对于手术预后的影响。

1 资料与方法

1.1 一般资料

选择2016年1月至2020年1月间HI患者共132例。诊断标准：根据意识状态、感觉异常、有无脑脊液漏、生命体征、小脑体征、眼部征象、损伤因素和头颅CT等综合因素进行诊断，发现额颞顶脑可见明显挫伤。……