摘要
目的比较标准大骨瓣与常规骨瓣减压术对重型颅脑损伤患者的疗效和并发症,为重型颅脑损伤患者手术治疗的标准化提供临床证据.方法回顾分析昆明医科大学第一附属医院神经外科2005年1月至2007年12月所收治符合标准的重型颅脑损伤患者共86例,其中,行标准大骨瓣减压术34例,常规骨瓣减压术41例,双额去骨瓣减压术9例,双侧去骨瓣减压术2例,主要比较标准大骨瓣减压术与常规骨瓣减压术临床疗效与并发症.结果伤后6个月GOS评分,标准大骨瓣组:预后良好23.5%,中残23.5%,重残26.5%,植物生存5.9%,死亡20.6%,常规骨瓣组:预后良好12.2%,中残9.8%,重残31.7%,植物生存9.8%,死亡36.6%,双额大骨瓣组:预后良好33.3%,中残33.3%,重残22.2%,植物生存11.1%;标准大骨瓣组疗效优于常规骨瓣组(P<0.05),标准大骨瓣组切口疝发生率明显低于常规骨瓣组(P<0.05),其他并发症无显著性差异.结论标准大骨瓣减压术治疗重型颅脑损伤疗效优于常规骨瓣减压术,但标准大骨瓣减压总体上不能降低并发症的发生率.
Objective To explore some clinical evidences to frame standardized severe traumatic brain surgeries by comparing the healing efficacies and aftermath-complications of standard large trauma craniotomy（SLTC）and routine temporoparietal craniotomy（RTC）.Methods We reviewed the effect and complications of 86 severe traumatic brain injured patients who received different type of craniotomies in the hospital during January 2005 to December 2007.Among those patients,34 were treated by SLTCs;41 received RTCs;9 were applied bi-frontal craniotomies;and 2 were implemented bilateral large craniotomies.The major focus is on the effect and complications of SLTCs and RTCs.Results By using GOS scoring at 6 month follow-up,16 cases were concluded positive healed（47.1%）,which include 8（23.5%）well recovery cases and 8（23.5%）moderate deficits cases.Other 18 cases were determined as negative healed（52.9%）,of which 9 were severe deficits,12 were in persistent vegetative conditions,and 7 died during their SLTCs.However,comparing to the SLTC,patients who received RTCs were statistically less advantaged.Only 9 cases were positive cures（22.0%）,including 5 well-recovery and 4 moderate deficits.Other 32 cases were assessed as negative cures（78.0%）,for which 13 were severe deficits,4 were under persistent vegetative conditions and 15 died in RTCs（P0.05）.However,except for incisional hernia,the incidences of complications were not significantly different between two groups（P0.05）.Conclusion For traumatic brain injured patients,SLTCs improve their healing outcomes significantly when compared to RTCs,but SLTCs couldn＇t reduce the complicationsincidence.
出处
《昆明医科大学学报》
CAS
2012年第9期110-114,共5页
Journal of Kunming Medical University
关键词
重型颅脑损伤
手术
标准大骨瓣
Severe traumatic brain injury
Surgery
Standard large bone flap
