目的：探讨评价改良大骨瓣减压术治疗高血压基底节区脑出血伴脑疝患者的效果，并与常规颞顶骨瓣减压术比较疗效差异。方法将我科2008年1月至2012年12月收治的60例高血压基底节区脑出血伴脑疝患者随机分为两组，每组30例。改良组采用改良大骨瓣减压术，常规组采用常规颞顶骨瓣减压术。术后治疗方案基本相同，术后随访6个月，按日常生活能力分级(ADL)评定疗效。结果改良组ADLⅠ级3例，Ⅱ级14例，Ⅲ级9例，Ⅳ级2例，V级1例，死亡1例。常规组ADLⅠ级1例，Ⅱ级9例，Ⅲ级10例，Ⅳ级6例，V级2例，死亡2例。需二次开颅手术常规组5例，改良组1例。经统计学处理，两组疗效的差异有统计学意义(P<0.05)。结论改良大骨瓣减压术在治疗高血压基底节区脑出血伴脑疝患者中有良好的效果，与常规颞顶瓣减压术比较，能减少二次开颅的概率，改善患者预后。%Objective To discuss the effect of modified large decompressive craniectomy in treating hyper-tensive basal ganglia hemorrhage complicated with cerebral herniation, and to compare the curative effect with that of the conventional craniotomy. Methods Sixty patients of hypertensive basal ganglia hemorrhage complicated with ce-rebral herniation between January 2008 and December 2012 in our department were randomly divided into two groups, with 30 cases in each group. The modified group was given modified big bone flap decompression, and the conventional group was given conventional temporal parietal bone decompression. The same postoperative treatment was given to patients in both groups. The patients were followed up for 6 months after the operation, and the clinical curative effect was evaluated according to activities of daily living (ADL). Results In the modified group, there were 3 cases of ADLⅠ, 14 cases of ADLⅡ, 9 cases of ADLⅢ, 2 cases of ADLⅣ, 1 case of ADLⅤand 1 case of death. As for the conventional group, there were 1 case of ADLⅠ, 9 cases of ADLⅡ, 10 cases of ADLⅢ, 6 cases of ADLⅣ, 2 cases of ADLⅤ and 2 cases of death. Second craniotomy was needed in 5 cases from the conventional group, and 1 from the modified group. The difference of curative effect between two groups was statistically signifi-cant (P<0.05). Conclusion Modified large decompressive craniectomy has a good effect in the treatment of hyperten-sive basal ganglia hemorrhage complicated with cerebral herniation, which can reduce the risk of second craniotomy and improve prognosis.
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