大骨瓣开颅与常规骨瓣开颅治疗重型颅脑损伤的效果比较

曾家良　谢飞　叶勇强

[摘要]目的 比较大骨瓣开颅与常规骨瓣开颅治疗重型颅脑损伤的效果。方法 选取我院2012年1月～2016年11月间收治的重型颅脑损伤患者320例，根据手术方式将患者分为观察组、对照组，每组160例。观察组给予大骨瓣开颅减压术，对照组给予常规骨瓣开颅术。比较两组的治疗效果。结果 观察组中，恢复良好51例，中度残疾30例，重度残疾29，植物生存27例，死亡23例；对照组恢复良好27例，中度残疾24例，重度残疾44，植物生存32例，死亡33例，观察组的治疗效果优于对照组（P<0.05）。结论 大骨瓣开颅减压术用于重型颅脑损伤患者有较好的疗效，优于常规骨瓣开颅减压手术，能明显降低患者的致残率、致死率。

[关键词]大骨瓣开颅；常规骨瓣开颅；重型颅脑损伤

[中图分类号] R651.1+5 [文献标识码] A [文章编号] 1674-4721（2017）06（a）-0061-03

[Abstract]Objective To compare the efficacy of large bone flap craniotomy and conventional bone flap craniotomy treating severe traumatic brain injury.Methods 320 patients with severe craniocerebral injury admitted into our hospital from January 2012 to November 2016 were selected and divided into observation group and control group according to the operation mode，each group had 160 cases.The observation group was treated with large bone flap craniotomy，while the control group was given conventional craniotomy.The treatment effect of two groups was compared.Results In the observation group，recovery was good in 51 cases，30 cases were moderate disability，29 severe were disability，plant survival was in 27 cases，23 cases were death，while in the control group，27 cases were good recovery，24 cases were moderate disability，44 cases were severe disability，32 cases were plant survival，33 cases were death.The curative effect of observation group was better than that of the control group （P<0.05）.Conclusion Large trauma craniotomy has a better curative effect in patients with severe craniocerebral injury，which is superior to the conventional craniotomy surgery，and it can obviously reduce the morbidity and mortality of the patients.

[Key words]Large bone flap craniotomy；Conventional bone flap craniotomy；Severe traumatic brain injury

隨着社会经济的快速发展，人们的社会活动也日益频繁，严重的颅脑损伤时有发生。它主要是暴力作用于颅脑引起的严重的颅骨骨折、颅内血肿、脑挫伤、脑水肿、颅内高压等。常常表现为意识障碍、头痛、恶心、呕吐、癫痫发作、肢体瘫痪、感觉障碍、失语及偏盲等，一般预后不良。虽然螺旋CT、磁共振应用于临床，诸多新技术新措施的广泛应用，但其致残致死率仍然居高不下，有资料显示通常在30%～60%[1]。为探讨积极有效的手术救治方法，选取我院采用手术治疗的320例重型颅脑损伤患者的临床病历资料，进行回顾性分析，比较两种手术方式的临床效果，现报道如下。

1资料与方法

1.1一般资料

选取2012年1月～2016年11月在我院采用手术治疗的320例重型颅脑损伤患者，格拉斯哥昏迷评分（GCS）≤8分的颅脑损伤患者；受伤后至入院时间为1～48 h。排除胸腹部损伤及肢体严重骨折等导致的休克、意识障碍。……