大骨窗开颅对不同分型颞叶脑挫裂伤手术患者预后的影响  

The influence of large bone window craniotomy on the prognosis of different types of temporal lobe brain contusion and laceration surgery

作　　者：陈轩[1] 姚宏伟[1] 李冰[1] 李齐印 刘永生[1] CHEN Xuan;YAO Hongwei;LI Bing;LI Qiyin;LIU Yongsheng(The First People’s Hospital of Shangqiu,Shangqiu 476100,China)

机构地区：[1]商丘市第一人民医院,河南商丘476100

出　　处：《中国实用神经疾病杂志》2021年第3期227-232,共6页Chinese Journal of Practical Nervous Diseases

基　　金：河南省医学科技攻关计划(编号:LHGJ20191493)。

摘　　要：目的探讨大骨窗开颅在不同分型颞叶脑挫裂伤手术中的效果及对预后的影响。方法回顾性分析2013-01—2019-08商丘市第一人民医院收治的颞叶脑挫裂伤患者51例的临床资料,根据临床表现和CT影像表现分为Ⅰ型、Ⅱ型、Ⅲ型,采用以岩骨脊为中心的更低位大骨窗开颅。比较不同分型的手术时间、术中出血量、术后住院时间,观察不同分型挫裂伤脑组织清除及弥漫性脑肿胀缓解情况,采用格拉斯哥预后量表(GOS)评价患者的预后情况。结果Ⅰ型患者手术时间及住院时间分别为(4.01±0.76)h、(19.45±3.98)d,均少于Ⅱ型、Ⅲ型患者,术中出血量(610.75±85.34)mL,低于Ⅱ型、Ⅲ型患者(P<0.05);Ⅱ型患者手术时间及住院时间(4.58±0.65)h、(25.31±4.32)d,均少于Ⅲ型的(5.13±0.71)h、(30.12±3.87)d,术中出血量(671.34±92.56)mL,低于Ⅲ型患者的(745.87±80.45)mL(P<0.05)。Ⅰ型、Ⅱ型、Ⅲ型的挫裂伤脑组织均清除,弥漫性脑肿胀均得到缓解。GOS评分显示,5分14例,4分28例,3分5例,2分3例,1分1例,预后良好率82.35%。结论对颞叶脑挫伤根据分型情况选择大骨窗开颅术治疗,具有良好的挫裂伤脑组织清除效果,有效缓解弥漫性肿胀,且预后良好。Objective To study the effect of large bone window craniotomy in different types of temporal lobe contusion and lac⁃eration surgery and its influence on the prognosis.Methods The clinical data of 51 patients with temporal lobe brain contusion and laceration admitted from January 2013 to August 2019 were selected for retrospective analysis.According to clinical manifestations and CT imaging manifestations,it is divided into three types,typeⅠ,typeⅡ,typeⅢ.The three types all use the lower large bone window with the petrous ridge as the center of the craniotomy.The operation time,intraoperative blood loss,and postoperative hospital stay of different types were compared,and different types of contusion and laceration of brain tissue removal and the relief of diffuse brain swelling were observed.The Glasgow outcome scale(GOS)was used to evaluate the prognosis.Results The operation time and hospital stay of typeⅠpatients were(4.01±0.76)h and(19.45±3.98)d,respectively,which were shorter than those of typeⅡand typeⅢpatients,and the intraoperative blood loss(610.75±85.34)mL was lower than typeⅡandⅢpatients(P<0.05).The opera⁃tion time and hospital stay of typeⅡpatients were(4.58±0.65)h and(25.31±4.32)d,respectively,which were shorter than those of typeⅢ(5.13±0.71)h and(30.12±3.87)d.The intraoperative blood loss(671.34±92.56)mL was lower than typeⅢ(745.87±80.45)mL(P<0.05).The brain tissue of typeⅠ,typeⅡ,and typeⅢcontusion and laceration were cleared and diffuse brain swell⁃ing was relieved.The GOS score showed that 14 cases with 5 points,28 cases with 4 points,5 cases with 3 points,3 cases with 2 points,1 case with 1 point,and the good prognosis rate was 82.35%.Conclusion For temporal lobe brain contusion,large bone win⁃dow craniotomy is selected according to the classification.It has a good effect of clearing brain tissue from contusion and laceration,ef⁃fectively alleviating diffuse swelling,and has a good prognosis.

关 键 词：脑挫裂伤 颞叶 弥漫性脑肿胀 重型颅脑创伤 大骨窗开颅术 

分 类 号：R651.11[医药卫生—外科学]