摘要
目的探讨冠状切口大骨瓣开颅术治疗双额叶脑挫裂伤的效果,并与分次双侧标准大骨瓣开颅术进行比较。方法 53例双额叶脑挫裂伤患者,按入院顺序单双日随机分为两组:观察组25例采取冠状切口大骨瓣开颅术,对照组28例行分次双侧标准大骨瓣开颅,观察比较两组患者的疗效及预后情况。结果观察组急性脑膨出率[16.0%(4/25)]明显低于对照组[32.1%(9/28)]。手术结束后瞳孔缩小率观察组[72.0%(18/25)]明显低于对照组[42.9%(12/28)]。术后随访6个月预后按格拉斯哥预后评分表(GOS),观察组预后良好或中残16例(64.0%),重残、植物生存状态5例(20.0%),死亡4例(16.0%);对照组预后良好或中残9例(32.1%),重残、植物生存状态11例(39.3%),死亡8例(28.6%)。两组术中急性脑膨出率、术后预后良好率和死亡率有显著差异(P<0.05)。结论冠状切口大骨瓣开颅术在双额叶脑挫裂伤的抢救中是一种有效的方法 ,可减少术中急性脑膨出发生率,有效减轻或解除颅高压,改善患者预后,降低致残率和死亡率。
Objective To explore the efficacy of large trauma craniotomy with bilateral frontal coronal incision for treating bilateral frontal lobe contusion, and compare with bilateral decompressive craniectomy by stages. Methods 53 patients of bilateral frontal lobe contusion were randomly divided by sequential single day after hospitalization into two groups. The observation group（23 cases） were treated with large trauma craniotomy with bilateral frontal coronal incision, the control group（28 cases） were given bilateral decompressive craniectomy by stages. The curative effect and prognosis of two groups were observed and compared. Results The occurrence rate of acute cephalocele was signally lower in observation group [16.0%（4/25）] than that in control group[32, l%（9/28）].The miosis rate after surgery was signally lower in observation group [72.0%（18/25）] than that in control group [42.9%（12/28）]. According to Glasgow outcome scale（GOS） score of six-month observation after operation, 16 cases （64.0%）of observation group got good recovery or moderate disability, 5 cases（20.0%）got severe disability, persistent vegetative state, and 4 cases（16%） were dead. Only 9 cases（32.1% ） of control group got good recovery or moderate disability, 11 cases （ 39.3% ） got severe disability, persistent vegetative state, and 8 cases（32.1%） was dead. The occurrence rate of acute cephalocele,the rate of good recovery and mortality between two groups had significant differences.（P〈0.05）. Conclusion Large trauma craniotomy with bilateral frontal coronal incision is an effective method to treat patients with bilateral frontal lobe contusion. It can decrease the occurrence rate of acute cephalocele, and observably relieve or ease intracranial hypertension, and it can improve the prognosis and reduce disabling rate and fatality rate.
出处
《当代医学》
2014年第7期44-45,共2页
Contemporary Medicine
关键词
冠状切口
双额叶
脑损伤
大骨瓣开颅术
Coronal incision
Bilateral frontal lobe
Brain injuries
Large trauma craniotomy
