【摘要】 目的 探讨标准外伤大骨瓣开颅术急诊治疗重型颅脑损伤的效果。 方法 采用标准外伤大骨瓣开颅而尽量保留骨瓣，彻底清除血肿及失活脑组织，充分内减压，配合脑室外引流，控制颅内高压。 结果 伤后6个月临床随访：28例患者中恢复良好10例，中残6例，重残3例，植物生存1例，死亡8例。手术后并发症：迟发性血肿5例，切口脑脊液1例，癫痫3例，脑穿通畸形2例，脑积水1例。结论 标准外伤大骨瓣开颅或保留骨瓣是急诊救治重型颅脑损伤患者较为理想的手术方法，能显著减少并发症，降低死亡率，提高病人的生存质量。
【关键词】 颅脑损伤 重型 急诊手术 标准外伤大骨瓣开颅术
Clinical analysis of standard large trauma craniotomy for emergency treatment severe traumatic brain injury in 28 patients
SONG Xi-wen,FANG Shu-ping,Shen Ji-ren,et al.Department of Neurosurgery, Shanghai Fengcheng Hospital, Shanghai 201411,China
【Abstract】 Objective To explore the clinical effect of standard large trauma craniotomy for severe head injury (HI). Methods Standard large trauma craniectomy was applied and possible bone resection was kept to clean intracranial hematoma and bad brain tissue to reduce intracranial pressure and control the increased intracranial pressure through ventricular puncture and drainage of cerebrospinal fluid. Results In 28 patients, 10 cases recovered, 6 cases suffered moderated disability, 3 cases were severely disabled, 1 case was living vegetatively and 8 cases were died. Postoperative combination: 5 cases of delayed intracranial hematoma; 1 case of incision cerebrospinal fluid fistula; 3 cases of epilepsy; 2 cases of porencephaly; 1 case of hydrocephalus. Conclusion Applying standard large trauma craniectomy and keeping possible bone resection is preferable for severe HI, which can greatly reduce complications and mortality rate and improve patients’ living quality.
【Key words】 head injury; severe; emergency operation; standard trauma bone section
重型颅脑损伤是目前所有创伤性疾病中死亡率最高的病患，随着工业化进程和人们生活水平不断提高，发病率有逐年升高的趋势，如何合理、有效地处理这类损伤一直是神经外科医师所必须面对的难点。重型颅脑损伤常合并严重脑水肿、恶性颅内高压，往往是致死的主要原因[1]。我院从2006年1月至今共急诊采用标准外伤大骨瓣开颅术[2]救治重型颅脑损伤患者28例，取得明显疗效，现总结报道如下。
1 临床资料
1.1 一般资料 从2006年1月至今共急诊采用标 准外伤大骨瓣开颅术救治重型颅脑损伤28例，其中 男21例，女7例;年龄12～76岁，平均36± 2岁;受伤原因：交通事故伤23例，坠落伤4例，打击伤1例;手术距离伤后时间1.5～35h，平均7.3h;单侧瞳孔放大15例，
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