标准外伤在骨瓣开颅术治疗脑疝形成重型颅脑外伤36例报告.docVIP

标准外伤在骨瓣开颅术治疗脑疝形成重型颅脑外伤36例报告 　　【摘要】 目的 介绍我院标准外伤大骨瓣开颅术在治疗重型颅脑外伤中的应用。方法 采用标准外伤大骨瓣开颅术治疗36例脑疝形成的重型颅脑外伤，经过6个月～1年的随。结果 36例中恢复良好的10例，中残11列，重残4列，植物生存3例，死亡8例病死率22％。结论 采用标准大骨瓣开颅术是治疗重型脑外伤的有效方法。 　　【关键词】标准外伤大骨瓣 颅脑外伤 　　 　　Treatment of Sever Craniocerebral Trauma with Cerebral Hernia by the Use of Standard Trauma Craniotomy with Large Bone Flap.Department of Neurosurgery,The Hospital Of TCM,Haian County 226600 Jiangsu Province,ChinaJiang Guo Chen Xu Department of Neurosurgery, Renji Hospital affiliated to Medical College of shanghai Jiaotong Univesrity, Shanghai 200127 　　【Abstract】Objective To use standard trauma craniotomy with large bone flap for treatment of wever craniocerebral trauma. Mothods Standard trauma craniotomy with large bone flap was used to treat 36 cases of wevere of severe craniocerebral trauma with cerbral hernia. They were followed-up for 6-12 months. Results Among 36 cases 10 cases got good results; 11 cases were considered moderately maimed; 4 cases were referred to as seriously mained; 3 cases became vegetables; 8 cases died. The mortality rate amounted to 22%.Conclusion Standard trauma craniotomy with large bone flap is an effective mithod for treatmented severe craniocerebral trauma. 　　【Key words】Standard trauma craniotomy with large flap;Craniocerbral trauma 　　【中图分类号】R651.1+5 　　【文献标识码】A 　　【文章编号】1814-8824(2008)-11-0016-02 　　 　　严重颅脑外伤，脑性裂伤合并高颅压脑疝的患者的手术方式存在不同的观点。近年来国内外主张采用标准外伤大骨瓣手术方式取得良好的效果。本文报道36例重型颅脑伤脑疝的患者采用标准外伤大骨瓣手术方法的疗效。 　　 　　1 资料与方法 　　 　　1.1 一般资料 本组36例，男22例，女14例；年龄14～72岁，平均年龄38岁，受伤入院时间1～7h平均受伤3h，受伤至手术时间1.5～16h，平均4h。受伤原因：车祸伤26例，高处坠落伤8例，跌伤1例，打击伤1例。 　　1.2 临床表现 单侧瞳孔散大24例，双例瞳孔散大12例；入院时评分3~5分，3分22例，4分8例，5分6例。 　　1.3 诊断 全部患者入院时均行头颅ＣＴ检查。一例额颞脑挫伤伴弥漫性脑肿胀12例；一侧额颞脑挫伤伴颅内血肿11例；巨大额颞硬膜外血肿5例，巨大的硬膜下血肿3例；硬膜下血肿伴跨中线额顶粉碎性骨折3例；多发性颅内血肿5例；合并胸腹腔脏器损伤18例。所有的患者颅脑ＣＴ均显示环池受压、变形或消失。 　　1.4 手术方法 　　1.4.1 手术切口 切口起自颧弓上耳屏前１cm，经耳廓上方向后延伸到顶骨下中线，然后沿正中线向额发际内［1］。亦可过顶骨正中线延至对侧额角发际处，但需保证起止点与术侧额骨颧突夹角不小于120度，以利于皮瓣的掀开。 　　1.4.2 骨瓣 可成游离骨瓣或颞肌骨瓣。颅骨钻孔5～6枚，依次为颧弓上耳屏前1CM处1枚（因所有患者均脑疝故第一枚骨孔形成后先行