单侧外伤大骨瓣减压窗手术与双侧去骨瓣减压开颅术治疗重型对冲性颅脑外伤的疗效对比

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[摘要] 目的 对比分析重型对冲性颅脑外伤患者分别采用单侧外伤大骨瓣减压窗手术以及双侧去骨瓣减压开颅术治疗的临床疗效。方法 根据不同的手术方式将方便选取该院2012年1月―2016年12月收治的62例重型对冲性颅脑外伤患者随机分为观察组（31例，采用双侧去骨瓣减压开颅术治疗）和对照组（31例，采用单侧外伤大骨瓣减压窗手术治疗），对比两组患者治疗效果、预后情况。结果 观察组患者恢复良好率（35.5%）明显高于对照组（22.6%），观察组患者死亡率（3.2%）明显低于对照组（22.6%）。两组患者术前颅内压差异无统计学意义（P>0.05），两组患者术后1、3、7 d颅内压相对于术前均有所下降（P

[关键词] 重型对冲性颅脑外伤；手术治疗；疗效对比

[中图分类号] R651 [文献标识码] A [文章编号] 1674-0742（2017）05（c）-0067-03

[Abstract] Objective To compare and analyze the clinical curative effect of large decompressive craniectomy of unilateral trauma and bilateral decompressive craniectomy in treatment of severe contrecoup traumatic brain injury. Methods 62 cases of patients with severe contrecoup traumatic brain injury admitted and treated in our hospital from January 2012 to December 2016 were convenient selected and randomly divided into two groups with 31 cases in each according to different operation methods， the observation group and the control group were respectively treated with bilateral decompressive craniectomy and large decompressive craniectomy of unilateral trauma， and the treatment effect and prognosis were compared between the two groups. Results The recovery good rate in the observation group was obviously higher than that in the control group，（35.5% vs 22.6%）， and the morbidity in the observation group was obviously lower than that in the control group（3.2% vs 22.6%）， and there was no obvious difference in the preoperative intracranial pressure between the two groups（P>0.05）， and the intracranial pressures at 1， 3 d and 7 d after operation decreased compared with those before operation（P

[Key words] Severe contrecoup traumatic brain injury； Operation treatment； Comparison of curative effect

重型Τ逍月脑损伤是一种常见的重型颅脑损伤类型，致残率、致死率都比较高，而且近年来发病率有逐渐升高的趋势[1]。一般重型对冲性颅脑损伤患者会伴有脑水肿、严重挫裂伤等并发症，病情严重的话可能会并发脑疝、颅内血肿等疾病，如果采用常规手术治疗容易对患者造成很大的创伤，术后容易导致急性脑膨出，也会导致其他并发症，术后恢复也比较慢，甚至可能对于患者生命健康安全造成严重威胁[2]。为探讨一种更有效、安全的手术治疗方式，该文对比分析了该院2012年1月―2016年12月收治的62例重型对冲性颅脑外伤患者分别采用双侧去骨瓣减压开颅术以及单侧外伤大骨瓣减压窗手术治疗的临床疗效，现报道如下。