大骨瓣开颅减压术在对冲性颅脑损伤治疗中的应用分析

闫学强　李晓龙　孙祯卿　吴杰

【摘要】 目的：探討对冲性颅脑损伤患者采取标准外伤大骨瓣开颅减压术治疗的效果。方法：回顾性分析2014年5月-2018年5月本院接收的86例对冲性颅脑损伤患者的临床资料，按照随机数字表法分为对照组（n=43，予以常规骨瓣开颅减压术）与观察组（n=43，予以标准大骨瓣开颅减压术），观察两组的治疗情况及相关指标变化。结果：观察组患者恢复良好率明显高于对照组，差异有统计学意义（P<0.05）;术后第3天，观察组患者术后GCS评分明显高于对照组，而颅内压明显低于对照组，差异均有统计学意义（P<0.05）;术后，观察组对侧血肿厚度及中线移位程度均明显低于对照组，差异均有统计学意义（P<0.05）;此外，术后，观察组患者白介素-4（IL-4）水平较对照组明显升高，白介素-2（IL-2）、

神经元特异性烯醇化酶（NSE）以及肿瘤坏死因子-α（TNF-α）水平均明显低于对照组，差异均有统计学意义（P<0.05）。术后随访3个月，观察组并发症发生率较对照组明显降低，差异有统计学意义（P<0.05）。结论：对冲性颅脑损伤患者采取大骨瓣开颅减压术治疗的疗效明显，可减轻机体炎症反应，减少并发症的发生，具有临床推广价值。

【关键词】 大骨瓣开颅减压术; 对冲性颅脑损伤; 中线移位程度; 对侧血肿厚度

【Abstract】 Objective：To explore the effect of standard craniotomy with large trauma craniotomy and decompression in patients with hedged craniocerebral injury.Method：The clinical data of 86 patients with offset craniocerebral injury admitted to our hospital from May 2014 to May 2018 were retrospectively analyzed，they were divided into control group（n=43，conventional craniotomy and decompression were performed）and observation group（n=43，standard large craniotomy and decompression were performed），according to the random number table method，the changes of treatment status and related indexes in the two groups were observed.Result：The recovery rate of the observation group was significantly higher than that of the control group（P<0.05）.Three days after surgery，GCS score of the observation group was significantly higher and intracranial pressure was significantly lower than those in the control group（P<0.05）;after surgery，contralateral hematoma thickness and degree of midline shift of the observation group were significantly lower than those in the control group（P<0.05）.After surgery，the level of IL-4 in the observation group was significantly higher than that of control group，the levels of IL-2，NSE and TNF-αin the observation group were significantly lower than those in control group（P<0.05）.Postoperative follow-up for 3 months，the incidence of complications in the observation group was significantly lower than that in the control group（P<0.05）.Conclusion：Large bone flap craniotomy for patients with hedged craniocerebral injury has obvious curative effect，it can reduce the inflammatory reaction of the body，reduce the incidence of complications，and it has clinical promotion value.

【Key words】 Large bone flap craniotomy decompression; Hedged brain injury; Degree of midline displacement; Thickness of the contralateral hematoma

First-authors address：Guangdong Sanjiu Brain Hospital，Guangzhou 510510，China

doi：10.3969/j.issn.1674-4985.2019.08.015

对冲性颅脑损伤是一种常见的颅脑外伤类型，常伴有急性硬膜下血肿及脑挫裂伤，具有较高的致残率及病死率。术中彻底清除坏死脑组织以及颅内血肿，使颅内高压明显降低是手术治疗的关键。既往采取的骨瓣开颅手术，由于骨窗范围不够大，导致减压不充分，术后易引发并发症，导致预后不佳。近年来，有研究显示，对冲性颅脑外伤患者采取标准外伤大骨瓣开颅减压术治疗的效果显著，预后良好[1]。本研究中通过对2014年5月-2018年5月本院接收的86例对冲性颅脑损伤患者临床资料进行回顾性分析，探讨对冲性颅脑损伤患者采取标准外伤大骨瓣开颅减压术治疗的疗效，现报道如下。

1 资料与方法

1.1 一般资料 回顾性分析2014年5月-2018年5月本院接收的86例对冲性颅脑损伤患者的临床资料，纳入标准：患者均符合创伤外科学诊断标准，表现为瞳孔变化、意识障碍等颅脑损伤;均有明确外伤史，致伤原因为坠落伤、车祸及跌伤，入院后CT显示大脑挫裂伤、颅内血肿及颅内出血。……