T型切口在复杂颅脑损伤急诊开颅术中的应用  

Application of T-shaped incision in craniotomy for patients with complicated traumatic brain injury

作　　者：段继新 石磊 钟治军 王承 吴云 韩令 于汉昌 刘渊 DUAN Ji-xin;SHI Lei;ZHONG Zhi-jun;YU Han-chang;LIU Yuan;HAN Ling;WANG Cheng;WU Yun(Department of Neurosurgery,Changsha Municipal Traditional Chinese Medicine Hospital,Changsha 410100,China)

机构地区：[1]长沙市中医医院(长沙市第八医院)神经外科

出　　处：《中国临床神经外科杂志》2019年第9期535-536,共2页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨T型切口在复杂颅脑损伤急诊开颅手术中的应用效果。方法回顾性分析2016年8月至2018年3月应用T型切口进行开颅手术救治的42例复杂颅脑损伤的临床资料。42例均急诊进行开颅探查+血肿清除术,根据术前头部CT表现均选择T型切口,其中第一次手术双侧T型切口15例,术中按照阶梯减压执行,双侧开颅采用双侧控制技术。结果双侧硬膜下血肿7例,双侧硬膜外血肿2例,双侧脑挫裂伤伴脑内血肿5例,一侧硬膜外血肿合并对侧脑挫裂伤伴脑内血肿或硬膜下血肿9例,一侧硬膜下血肿合并对侧脑挫裂伤伴脑内血肿或硬膜外血肿19例。术后2例颅后窝开颅切口处因是直接着力点,愈合差,经重新缝合及换药处理均愈合;其他40例伤口愈合良好。术后1周神志好转25例,神志清楚6例,无变化11例;术后1个月神志好转18例,神志清楚14例。术后3个月按GOS评分评估预后:恢复良好11例,中残15例,重残2例,植物状态6例,死亡8例。结论在复杂颅脑损伤急诊手术中,特别是需要双侧开颅手术时,以及可能出现进展、变化的病例,T型切口具有一定的优势,有助解决复杂颅脑损伤急诊开颅手术中的切口设计难题。Objective To investigate the outcomes and indications of craniotomy with T-shaped incision in the patients with complicated traumatic brain injury (CTBI).Methods The clinical data of 42 patients with CTBI,who underwent craniotomy with Tshaped incision from August,2016 to March,2018,were analyzed retrospectively.All the patients underwent emergency craniotomy under general anesthesia.Of 42 patients,15 underwent bilateral T-shaped incisions craniotomy according to the gradient decompression and bilateral control technology and 27 unilateral T-shaped incisions craniotomy according the gradient decompression.Results Of 42 patients,11 (26.2%) were recovered well,15 (35.7%) medially disabled,2 (4.8%) severely disabled,6 (14.3%) vegetatively survived,and 8 (19%) died according to GOS score 3 months after the operation.Conclusion The T-shaped incision had certain advantages in the patients with CTBI,especially in the patients with progressive CTBI or needing bilateral craniotomy because it may solve the problem of incision design of craniotomy for the complex traumatic intracranial hematomas.

关 键 词：复杂颅脑损伤 颅内多发血肿 双侧开颅 T型切口 

分 类 号：R651.15[医药卫生—外科学] R651.11[医药卫生—临床医学]