两种不同开颅方法治疗重型颅脑损伤对其病死率影响.doc

两种不同开颅方法治疗重型颅脑损伤对其病死率影响 　 作者：周新军　韩东华　闵志钧　沙龙贵　李振华　徐明　倪春明 【关键词】 颅脑损伤 　　【摘要】 目的 比较标准外伤大骨瓣与常规骨瓣开颅术治疗82例重型颅脑损伤的效果及对重型颅脑损伤病死率的影响。方法 将我科2000年1月~2005年12月手术的82例额颞顶重型颅脑损伤（GCS 3~8分）病人分成两组：（1）2000年1月~2004年7月根据出血部位采用常规额颞或颞顶骨瓣开颅手术35例。（2）2004年8月~2005年12月采用标准外伤大骨瓣开颅手术47例。所有病人都经CT证实颅内损伤情况。根据GCS评价病人预后。结果 术后平均6个月随访，常规骨瓣组：恢复良好13例，中残4例，重残2例，植物状态2例，死亡14例。标准外伤大骨瓣组：恢复良好20例，中残13例，重残3例，植物状态2例，死亡9例。排除了术前GCS评分、性别构成及发病至手术时间的影响，标准外伤大骨瓣治疗重型脑损伤疗效好于常规骨瓣开颅术，病死率明显降低（P＜0.05）。结论 标准外伤大骨瓣治疗重型脑损伤较常规骨瓣开颅术能明显降低重度颅脑损伤的病死率。 　　【关键词】 颅脑损伤；标准外伤大骨瓣；常规骨瓣；治疗 　　The influence of two different craniotomies on the mortality of severe craniocerebral trauma 　　【Abstract】 Objective To compare the effect of standard large trauma craniotomy versus routine craniotomy on the outcome of 82 cases of severe head injury and their influence on mortality of severe head injury.Methods 82 patients with fronto and temporo parietal severe injury （GCS≤8） in our department from January 2000 to December 2005 were divided into two groups.（1）35 patients from January 2000 to July 2004 underwent temporo parietal or fronto parietal craniotomy according to the position of hematomas as a routine （RC） group.（2） 47 patients from Auguest 2004 to December 2005 underwent standard large trauma craniotomy （SLTC） as a SLTC group.All patients got their CT scan.The prognosis of the patients was evaluated according to Glasgow outcome scale （GOS）.Results GOS was recorded at average 6 months follow-up.13 patients got good outcome,4 patients got moderate disability,2 patients got severe disability,2 patients got vegetative survival and 14 died in RC group.20 patients got good outcome,13 patients got moderate disability,3 patients got severe disability,2 patients got vegetative survival and 9 died in SLTC group.After getting rid of the influence of sex、GCS before operation and the time from suffering from disease to operating,the effect of SLTC on severe head injury is better than RC,the mortality of SLTC is lower apparently than RC（P＜0.05）.Conclusion SLTC redu