标准外伤大骨瓣开颅术治疗重型颅脑损伤分析

摘要

Objective To compare the effect of standard large trauma craniotomy versus routine craniotomy on outcome of 91 severe traumatic brain injured patients(Glosgow Coma Scale, GCS≤8). Methods 91 patients with an admission Glasgow Coma Scale score of 8 or less were randomLy divided into two groups:standard large trauma craniotomy group (n=48) received unilateral or bilateral frontotemporoparietal bone flap (12cm×15cm) and routine temporoparietal craniotomy group (n=43) got routine temporoparietal scalp flap (6cm×8cm ). All patients received CT scan. Results Glasgow outcome scale at mean 8 months follow-up, 20 cases got favorable outcome (41.67%), including 8 good recoveries and 12 cases moderate deficit, other 28 cases got unfavorable outcome (58.33%), including 9 severe deficits, 6 persistent vegetative status and 13 were dead in standard large trauma craniotomy group. However, only 8 cases got favorable outcome (18.60%), including 4 good recoveries and 4 cases moderate deficit, and other 35 cases got unfavorable outcome (81.40%), including 15 severe deficits, 3 persistent vegetative status and 17 were dead in routine temporoparietal craniotomy group (P<0.05). The incidence of acute encephalomyelocele, delayed intracranial hematomas, reoperation and CSF fistulae in standard large trauma craniotomy group was lower than those in routine temporoparietal craniotomy group (P<0.05). However, the incidence of traumatic hydrocephalus, traumatic seizure and intracranial infection was not significantly different between two groups (P>0.05). Conclusion Standard large trauma craniotomy significantly improves the outcome of severe traumatic brain injured patients.%　　目的比较标准外伤大骨瓣与常规骨瓣开颅术治疗重型颅脑损伤的效果.方法符合重型颅脑损伤诊断标准的患者91例，分标准外伤大骨瓣治疗组和常规骨瓣对照组两组.标准外伤大骨瓣治疗组(n=48)，行单侧或双侧额颞顶标准外伤大骨瓣开颅减压术；常规骨瓣对照组(n=43)，行单侧或双侧颞顶瓣或额颞瓣开颅术.所有患者都经CT扫描证实颅脑损伤情况.结果伤后随访，标准外伤大骨瓣治疗组：20例预后较好(41.67%)，其中恢复良好8例，中残12例；28例预后较差(58.33%)，其中重残9例，植物状态6例，死亡13例；常规骨瓣对照组：8例预后较好(18.60%)，其中恢复良好4例，中残4例；35例预后较差(81.40%)，其中重残15例，植物状态3例，死亡17例，两者比较差异有统计学意义(P<0.05).标准外伤大骨瓣治疗组的术中急性脑膨出、迟发性血肿、再次手术、脑脊液漏发生率低于常规骨瓣对照组(P<0.05)，但两组患者术后外伤性脑积水、术后外伤性癫痫和颅内感染发生率差异无统计学意义(P>0.05).结论标准外伤大骨瓣开颅减压术治疗重型颅脑损伤效果优于常规骨瓣开颅术.