摘要
目的:探讨3种术式对重症对冲性颅脑损伤术后对侧血肿厚度及中线位移的影响。方法:收集我院脑外科2012年6月~2014年6月收治的重症对冲性颅脑损伤60例,按照手术开颅血肿清除手术治疗方式不同分为3组,分别为额颞部单侧清除联合去骨瓣减压术组(A组,23例)、额颞部双侧清除联合单侧或双侧去骨瓣减压术组(B组,17例)、先行受伤部位硬膜外除术再行对侧硬膜外血肿清除术组(C组,20例),CT扫描复查对侧血肿厚度及中线位移程度变化。结果:术前3组GCS评分之间差异无统计学意义(P>0.05),术后1、3、7d3组GCS评分之间差异具有统计学意义(P<0.05),其中术后1、3、7dA组与B组、C组与B组之间差异具有统计学意义(P<0.05),A组与C组之间差异无统计学意义(P>0.05);组内随着时间延长GCS评分逐渐升高,差异具有统计学意义(P<0.05)。术前所有患者经过CT扫描检查对侧血肿厚度、中线位移程度在3组之间差异无统计学意义(P>0.05),术后CT复查检查这两指标在3组之间差异具有统计学意义(P<0.05),其中A组与C组、B组与C组之间差异具有统计学意义(P<0.05),A组与B组之间差异无统计学意义(P>0.05);对侧血肿厚度与中线位移程度在3组中术后与术前相比差异均具有统计学意义(P<0.05)。结论:重症对冲性颅脑损伤二次开颅手术较常见,不同手术方式均可以改善对侧血肿厚度及中线位移程度,并且在先处理硬膜外血肿可以可能效果更好。
Objective： To investigate three surgical methods on postoperative contralateral hematoma thickness and mid- line shift degree of patients of hedge severe brain injury. Methods.. A total of 60 cases of brain surgery in our hospital with se- vere brain injury hedging were collected from June 2012 to June 2014. In accordance with surgical hematoma evacuation surgi- cal treatment they were divided into three groups, namely frontotemporal unilateral clear joint decompressive craniectomy group （A, 23 cases）, frontotemporal unilateral or bilateral joint bilateral clearing decompressive craniectomy group （group B, 17 patients）, in addition to leading the injured area epidural surgery again contralateral epidural hematoma group （group C, 20patients）. CT scan was used to screen contralateral hematoma thickness and extent of changes in midline shift. Results： The difference in preoperative GCS score among three groups was not statistically significant （P^0.05）, the difference in the post- operative ld, 3d, 7d GCS score was statistically significant （P〈0.05）. After 1 d, 3 d, 7 d the difference between group A and group B, or between group C and group B was statistically significant （P〈0.05）, but the difference between group A and group C was not statistically significant （P〉0.05）. The extend GCS score was gradually increased, and the difference was sta- tistically significant （P〈0.05）. Before surgery, CT scan showed that there was no significant difference in contralateral hema- toma thickness, or degree of midline shift among three groups （P〉0.05）, but after surgery, the difference was significant （P 〈0.05）. The difference between group A and group C, or between group B and group C was statistically significant （P〈 0.05）, but not statistically significant （P〉0.05） between group A and group B. Difference in hematoma thickness and lateral extent of midline shift were statistically significant after surgery （P〈0.05） in the three groups. Conclusions.. Secondary crani otomy is common treatment for hedge severe brain injury. Different surgical methods can improve the contralateral hematoma thickness and extent of midline shift. The earlier treatment time of eDidural hematoma is. the hotter the efficacy is.
出处
《海南医学院学报》
CAS
2015年第5期667-669,共3页
Journal of Hainan Medical University
基金
青岛市卫生系统基金(28171223)~~
关键词
开颅手术
颅脑损伤
对侧血肿
中线位移
Craniotomy
Traumatic brain injury
Contralateral hematoma
Midline shift
