颅脑外伤急性硬膜下血肿标准去大骨瓣减压术疗效分析附24例病例报告外科学神经外科专业论文.docxVIP

优秀毕业论文 精品参考文献资料 硕士学位论文 硕士学位论文 中文摘要 摘要 目的：探讨颅脑外伤标准大骨瓣开颅术治疗急性硬膜下血肿的临床 效果。 方法：回顾性分析湘雅医院2004年11月．2007年12月湘雅医院收 治资料完整的35例急性硬膜下血肿患者。所有患者均有明确外伤史，术 前CT经确诊，手术分为标准脑外伤去大骨瓣减压术(24例)及骨瓣回纳 术(1 1例)(即清除颅内血肿后放回骨瓣)，术后CT复查并分析其临床 效果。 结果：去大骨瓣减压组死亡5例，植物状态9例，重残1例，中残4 例，恢复良好5例；骨瓣回纳组死亡1例，植物状态1例，重残0例，中 残2例，恢复良好7例。 结论：标准外伤去大骨瓣减压术简单、安全、有效，为治疗重型颅 脑损伤患者提供了良好的手术方式，但其在降低死亡率(20．8％)的同时， 有着相对较高的伤残率和手术后的多种并发症。在本组有限的病例中，骨 瓣纳回组的效果优于去骨瓣组效果，这对今后的治疗提供了一个线索。但 是骨瓣纳回要慎重，选择病例要恰当，否则有再次行去大骨瓣减压的可能。 关键词：颅脑外伤，急性硬膜下血肿，标准外伤去大骨瓣减压术， 并发症 硕士学位论文 硕士学位论文 英文摘要 ABSTRACT objective：To investigate the surgical techniques and clinical outcome of decompressive craniectomy in the treatment of acute subdural hematoma． Methods：35 cases with acute subdural hematoma of xiangya hospital who had received Standard large trauma craniotomy from November 2004 to December 2007 were analyzed retrospectively．All cases had certain traumatic history and were confirmed through CT．24 cases underwent decompressive craniectomy,and in the other 11 cases，the cranial flap was restored after operation．All patients underwent postoperative CT． Results：In the decompressive craniectomy group，the outcome of patients was：5 deaths，9 were in vegetative state，1 had severe disability,4 had moderate disability and 5 had good recovery．In the restored cranial flap group， the outcome was：l death，1 Was in vegetative state，no cases had severe disability,2 had moderate disability and 7 had good recovery． Conclusion：The simple，safe and effective standard large trauma craniotomy provide better operation mode for severe brain injury．While， this technique reduces fatality rate(20．8％)，it also results in a high physical disability rate and has got many postoperative complications．In few cases in this series，the effectiveness of the restored cranial flap group is superior to decompressive craniectomy group．Th