摘要
目的：分析标准外伤大骨瓣开颅术（Standard large trauma craniotomy）治疗额颞部重型颅脑损伤的临床疗效。方法：应用美国标准外伤大骨瓣开颅术治疗额颞部重型颅脑损伤。使其骨窗下界平颧弓并咬除蝶骨嵴以显露前、中颅窝,前至额极,后达乳突前。硬脑膜常采用减张缝合。结果：该术式暴露范围广,能清除手术侧额颞顶部所有急性颅内血肿或脑坏死组织,有效降低颅内压。随访半年,存活率为67.95%,病死率为32.05%。存活者ADLⅠ-V级分别为30.77%、19.23%、10.26%、3.85%、3.85%。结论：重型颅脑损伤,尤其是广泛额颞顶脑挫裂伤或急性硬膜下血肿伴有高颅压的病人,标准外伤大骨瓣手术能获得满意的治疗效果。
Objective：To evaluate the clinical effect of treating patients with severe head iniury in frontotemporal by standard large trauma craniotomy. Methods： The data of 78 cases were collected from 2002 to 2006. By employing U.S. standard large trauma craniotomy, surgical procedure was initiated by extending the bone window to the descending horizontal boarder line of zygomatic arch with anteriorly going to frontal pole and posteriorly reaching frontal mastoid process and gouging off the crest of sphenoid hone for exposing both anterior and middle cranial fossa, and tension-reduced suture was used for cerebral dura mater. Results： A half-year follow-up suggested that the survival rate was 67.95% compared with a case fatality rate of 32.5%. By the grading scale of activity of daily living（ADL）, grade Ⅰ accounted for 24 cases （30.77%）, Ⅱ, 15（19.23%）, Ⅲ, 8（10.26%）, Ⅳ, 3（3.85%） and Ⅴ , 3 （3.85 % ）, respectively. Conclusion ： This procedure predominates itself in wider operative field and can remove the intracranial hematoma and necrotic tissues resulted from acute head injury in pterion and effectively reduce intracranial pressure. Therefore, standard large trauma craniotomy is effective in treating patients with severe craniocerebral injury, especially those with extensive contusions and lacerations of head in pterion complicated with subdural hematoma and increased intracranial pressure.
出处
《皖南医学院学报》
CAS
2008年第1期48-50,共3页
Journal of Wannan Medical College
关键词
标准外伤大骨瓣开颅术
重型颅脑损伤
手术治疗
standard large trauma craniotomy
severe traumatic brain injury
surgical intervention
