颅内血肿去骨瓣减压造成继发性脑损伤54例临床分析.docVIP

颅内血肿去骨瓣减压造成继发性脑损伤54例临床分析 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：颅内血肿去骨瓣减压造成继发性脑损伤54例临床分析 1 1对象和方法 2 13统计学方法组间比较采用χ2检验，以α=为检验标准。 3 文2：去骨瓣减压造成继发性脑损伤54例临床分析 5 1对象和方法 5 参考文摘引言： 8 原创性声明（模板） 9 文章致谢（模板） 9 正文 颅内血肿去骨瓣减压造成继发性脑损伤54例临床分析 文1：颅内血肿去骨瓣减压造成继发性脑损伤54例临床分析 Abstract： ObjectiveTo study the cause of cerebral injury secondary to decompression via removal of bone flap for intracranial hematoma, as well as the approach to its total of 267 patients, who underwent decompression via removal of frontal and temporal bone flaps for intracranial hematomata between 1998 and 2006, were divided into three groups according to the size of the bone window, . Group A (5×7-6×11 cm2, n=72), Group B (7×12-11×14 cm2, n=103) and Group C (12×15 cm2 or larger, n=92). The movement of the upper limbs opposite to the hematomata or the linguistic ability was recorded before operation and at early stage after operation, and then compared with that of postoperation. ResultsSecondary cerebral injury occurred in 54 cases. The incidence was % (37/103) in Group B, whereas it was lower in Group A (%, 7/72) or Group C (%, 10/92). Those who were performed the repair of duramater suffered no secondary cerebral injury. ConclusionCerebral injury secondary to decompression via removal of bone flap, which is inclined to occur in the patients with middlesized bone window, ought to be paid attention to. To repair duramater is a good approach to its prevention. Key words： intracranial hematoma; decompression; secondary cerebral injury 去骨瓣减压是神经外科 治疗 严重的颅脑损伤，增加颅腔容积，缓解颅内压增高的常用有效手段， 由于去骨瓣减压脑组织缺血再灌注脑组织由减压窗呈蕈样膨出，引起脑组织的嵌顿导致局部脑组织的水肿加重而造成的新的神经功能损害，我科267例此类手术病人有54例发生继发于去骨瓣减压造成的脑组织由骨窗部疝出而引发的神经功能障碍。现分析报告如下。 1对象和方法 对象 为本院1998—2006年颅脑损伤后行额颞部去骨瓣减压患者267例，其中男182，女85例，年龄4~72（平均）岁。 单纯硬膜外血肿94例；硬膜下血肿及脑挫裂伤141例；硬膜外合并硬膜下血肿32例， 右侧血肿176例，左侧血肿91例。手术采用“马蹄形”或“倒问号”切口，行额颞部的骨瓣或骨窗， 其中37例取自体颞肌筋膜行硬脑膜减张修补术，其余病例均行放射状剪开硬膜，未予修补。 方法 本组病例均选择行单侧额颞部去骨瓣减压并存活出院的病例。 入选病例来院时或术后早期血肿对侧上肢有活动或躁动或刺激后有活动的记录。 术后4 d，患者骨窗对侧上肢肌力下降，甚至为0级，同时CT扫描