冠切双额大骨瓣减压术治疗双额颞重度脑挫裂伤合并脑中心疝及早期颅骨修补  

Bifrontal decompressive craniectomy via bilateral frontal coronal incision for treatment of patients with contusion and laceration of bilateral frontal and temporal lobes and early cranioplasty

作　　者：王忠 贾文彬 苏宁 张晓军 戚建军 赵卫平 张义松 张仲 

机构地区：[1]内蒙古自治区人民医院神经外科,呼和浩特010017 [2]山西大同市卧虎湾预备役高炮团卫生队

出　　处：《临床神经外科杂志》2015年第5期372-374,共3页Journal of Clinical Neurosurgery

基　　金：内蒙古自治区科技厅项目(20120401);内蒙古自治区卫生厅项目(2010002)

摘　　要：目的探讨应用冠切双额大骨瓣减压术对重型双侧额颞叶脑挫裂伤及早期颅骨修补的效果。方法回顾性分析冠切双额大骨瓣开颅手术治疗的56例重型双侧额颞叶脑挫裂伤伴难治性高颅内压患者的临床资料。术后随访6个月,以格拉斯哥预后量表(COS)评分判定患者的疗效。结果本组患者恢复良好33例,轻残12例,重残5例,植物生存3例,死亡3例。恢复良好的患者中早期行自体或塑形钛网颅骨修补术28例。结论双额冠状切口大骨瓣减压术能有效解除或减轻双额颞叶脑挫裂伤患者的颅内高压,在重型双侧额颞叶脑挫裂伤的抢救中是一种有效的方法,能明显提高抢救成功率,降低致残率和病死率,改善患者的预后。Objective To explore the efficacy of bifrontal decompressive craniectomy via bilateral frontal coronal incision in treating severe contusion and laceration of bilateral frontal and temporal lobes and early cranioplasty. Methods The clinical data of 46 patients with contusion and laceration of bilateral frontal and temporal lobes who were treated with bilateral decompressive craniectomy were analyzed retrospectively. The prognosis were evaluated at 6 months after surgery by Glasgow outcome scale（ GOS） score. Results There were 33 cases who got good recovery,12 cases with moderate deficit,other 5 cases got severe deficit,3 cases with persistent vegetative status and 3cases death. 20 cases who got good recovery were treated early cranioplasty with in vitro bone flap or computer-assisted design titanium mesh after bifrontal decompressive craniectomy 1-3 month.Conclusions bifrontal decompressive craniectomy with bilateral frontal coronal incision in treating severe contusion and laceration of bilateral frontal and temporal lobes can significantly relieve severe intracranial hypertension of patients with contusion and laceration of bilateral frontal and temporal lobes. And it can improve the prognosis obviously and increase the rate of successful rescue and decrease the rate of mortality and disability.

关 键 词：冠状切口 双额大骨瓣减压术 额颞叶脑挫裂伤 早期颅骨修补 

分 类 号：R651.1[医药卫生—外科学]