摘要:
Objective To analyze the clinical effect of modified standard traumatic craniectomy and standard large trauma craniectomy in the treatment of severe craniocerebral trauma.And to evaluate the clinical value of modified standard traumatic craniectomy in the treatment of severe craniocerebral trauma.Methods Ninety-two patients with severe craniocerebral trauma treated in Rugao Bo'ai Hospital (GCS3-8,acute subdural hematoma)from January 2015 to January 2017 were divided into two groups using random envelope drawing method,with 46 cases in each group.The control group was treated by standard large trauma craniectomy,and the observation group was treated by modified standard traumatic craniectomy.The intracranial pressure levels and activity of daily living scale (ADL) were compared between the two groups.Results At 1 d,5 d,10 d after operation,the intracranial pressure levels of the observation group were (23.19 ± 2.82) mmHg,(15.26 ± 2.77) mmHg and (11.22 ± 2.75) mmHg,respectively,which were lower than those of the control group[(28.12 ± 2.32) mmHg,(19.14 ± 2.17) mmHg and (14.23 ±2.17) mmHg] (t =47.544,37.922,29.504,all P < 0.05).At 6 months after operation,according to ADL,the good rate of postoperative recovery in the observation group (67.39%,31/46) was significantly higher than the control group (45.65 %,21/46),the difference was statistically significant (x2 =4.423,P < 0.05).Conclusion The modified standard traumatic craniectomy has a certain value in the treatment of patients with severe craniocerebral trauma.%目的 比较改良标准大骨瓣开颅术与标准外伤大骨瓣开颅术在重型颅脑外伤患者治疗中的效果,探讨改良标准外伤大骨瓣开颅术的应用价值.方法 选择如皋博爱医院2015年1月至2017年1月收治的重型颅脑外伤患者(格拉斯哥昏迷指数评分3~8分,急性硬膜下血肿)92例为研究对象,采用随机信封抽签法将其分为对照组46例、观察组46例,对照组给予传统标准外伤大骨瓣开颅术,观察组采用改良标准外伤大骨瓣开颅术治疗,比较两组患者术后颅内压水平,采用日常生活能力量表(ADL)评估两组患者6个月后的神经功能.结果 观 察组术后1d、5d、10 d的颅内压分别为(23.19 ±2.82) mmHg、(15.26±2.77) mmHg、(11.22±2.75) mmHg,均低于对照组的(28.12±2.32) mmHg、(19.14±2.17) mmHg、(14.23±2.17) mmHg(t=47.544、37.922、29.504,均P<0.05);术后6个月,根据ADL分级,观察组Ⅰ、Ⅱ级31例(67.39%),高于对照组的21例(45.65%),两组差异有统计学意义(x2 =4.423,P<0.05).结论 改良标准外伤大骨瓣开颅术在重型颅脑外伤患者治疗中的效果优于标准外伤大骨瓣开颅术.