两种颞肌分离方法在重型颅脑外伤患者标准大骨瓣减压术中的应用  

The application of two flap dissection methods in the standard large decompressive craniectomy

作　　者：陈涛[1] 李春辉[1] Chen Tao;Li Chunhui(Department of Neurosurgery,the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Changsha 410007,China)

机构地区：[1]湖南中医药大学第一附属医院神经外科,长沙410007

出　　处：《中国医师杂志》2022年第4期547-550,共4页Journal of Chinese Physician

基　　金：湖南省卫生健康委科研立项课题(202104040148)。

摘　　要：目的比较电刀分离皮瓣法与神经剥离子分离皮瓣法在标准大骨瓣减压术(SLDC)中的应用效果。方法收集和纳入2020年1月至12月湖南中医药大学第一附属医院收治的40例符合标准并拟行SLDC手术的重型颅脑外伤患者,根据颞肌分离方法不同分为电刀分离组20例和神经剥离子分离组20例。对比两组在SLDC手术中皮瓣分离所消耗的时间、术后手术侧颞肌水肿程度、颞肌萎缩程度的差异。结果两组患者皮瓣分离时间差异无统计学意义[(20.91±12.33)min vs(29.92±12.69)min,t=1.799,P>0.05]。两组患者术后48 h均出现不同程度的颞肌水肿,电刀分离组患者术后颞肌水肿程度重于神经剥离子分离组[(18.82±5.23)cm^(3) vs(10.71±3.69)cm^(3),t=7.314,P<0.05]。两组患者术后3个月均出现不同程度的颞肌萎缩,电刀分离组患者术后3个月颞肌萎缩程度重于神经剥离子分离组[(8.26±2.38)cm^(3) vs(6.72±2.13)cm^(3),t=2.314,P<0.05]。结论在SLDC手术中,电刀分离皮瓣法与神经剥离子分离皮瓣法在皮瓣分离时间上差异无统计学意义,但神经剥离子分离皮瓣法对颞肌损伤小,患者术后颞肌萎缩程度轻。Objective To compare the application effect of electrotome flap separation and neuro dissector in standard large decompressive craniectomy(SLDC).Methods From January 2020 to December 2020,40 patients with severe craniocerebral injury who met the standard and planned to undergo SLDC were randomly divided into two groups:20 patients in the electrotome separation group and 20 patients in the nerve dissector group.The time of flap seperation,the degree of edema and atrophy of temporal muscle on the operation side were compared between the two groups.Results There was no significant difference in the time of flap separation between the two groups[(20.91±12.33)min vs(29.92±12.69)min,t=1.799,P>0.05].The patients in the two groups had different degrees of temporal muscle edema 48 hours after operation.The degree of temporal muscle edema in the electrotome separation group was more serious than that in the nerve dissector group[(18.82±5.23)cm^(3) vs(10.71±3.69)cm^(3),t=7.314,P<0.05].The degree of temporal muscle atrophy in the electrotome separation group was higher than that in the nerve dissector group[(8.26±2.38)cm^(3) vs(6.72±2.13)cm^(3),t=2.314,P<0.05].Conclusions In SLDC surgery,there was no significant difference in flap separation time between electrotome separation flap method and neuro dissector flap separation method,but the latter had less damage to temporal muscle and less atrophy of temporal muscle after operation.

关 键 词：颅脑损伤 减压颅骨切除术 颞肌 电刀分离皮瓣法 神经剥离子分离皮瓣法 

分 类 号：R651.15[医药卫生—外科学]