紧急颞下减压后大骨瓣减压联合小脑幕切开术治疗重型颅脑损伤合并小脑幕切迹疝临床观察  

Clinical observation on trauma maximus bone flap craniotectomy decompression combined with tentorium cerebelli hiatus incision after emergency subtemporal decompression in treatment of severe brain injury Complicated from tentorial herniation.

作　　者：唐协林[1] 夏祥国[1] 刘增进[1] 顾应江[1] 李春绒[1] 刘运超[1] 

机构地区：[1]泸州医学院附属医院神经外科,646000

出　　处：《中国综合临床》2009年第1期99-101,共3页Clinical Medicine of China

摘　　要：目的探讨施行紧急颞下减压后大骨瓣减压联合小脑幕切开术治疗重型颅脑损伤合并小脑幕切迹疝的作用。方法对92例重型颅脑损伤合并颞叶钩回疝患者随机分为2组，42例采用紧急颞下减压后大骨瓣减压联合小脑幕切开术，50例采用标准外伤大骨瓣开颅减压术。均进行术前、术后头颅CT及颅内压的监测；对幸存者术后3个月至1年随访，按GOS预后标准评价，并对其并发症进行统计。结果紧急颞下减压后大骨瓣减压联合小脑幕切开术病例组疗效优于标准外伤大骨瓣减压组（P〈0．05）。结论小脑幕切迹疝施行紧急颞下减压后大骨瓣减压联合小脑幕切开术治疗重型颅脑损伤合并颞叶钩回疝可迅速解除脑受压、缓解颅内高压、挽救生命、改善预后。Objective To explore the clinical effect of trauma maximus bone flap craniotectomy decompression combined with tentorium eerebelli hiatus incision after emergency subtemporal decompression in treatment of severe brain injury complicated from tentorial herniation. Methods 92 patients with severe brain injury complicated with tentorial herniation were randomly divided into two groups. 42 cases of severe brain injury with secondary brain stem injury resulted from tentorial herniation were treated with trauma maximus bone flap eraniotectomy decompression combined with tentorlum cerebelli hiatus incision after emergency subtemporal decompression in the treatment of severe brain injury complicated from tentorial herniation, and 50 cases were treated with standard trauma maximus bone flap craniotectomy decompression. Intracranial pressure was monitored. CT was performed before and after surgery. Survivors were followed up from 3 to 12 months to determine their Glasgow Outcome Scale （GOS） score. Resuits The therapeutic effect of the group of the trauma maximus bone flap eraniotectomy decompression combined with tentorium eerebelli hiatus incision after emergency subtemporal decompression was better than that in standard trauma maximus bone flap craniotectomy decompression （ P 〈 0.05 ）. Condusion The trauma maximus bone flap craniotectomy decompression combined with tentorium cerebelli hiatus incision after emergency subtemporal decompression in treatment of severe brain injury complicated from tentorial herniation is associated with better-than-expected outcome for treating traumatic intracranial hematomas accompanied by tentorial herniation, with such advantages as lowering the disability and mortality in these patients.

关 键 词：紧急颞下减压 标准外伤大骨瓣减压 小脑幕切开术 重型颅脑损伤 颞叶钩回疝 

分 类 号：R651.15[医药卫生—外科学] R651.2[医药卫生—临床医学]