摘要
目的探讨运用改良大骨瓣开颅内外减压手术及常规开颅手术治疗急性颅脑损伤的效果。方法回顾性分析2016年1月~2018年1月我院收治的100例急性颅脑创伤患者的临床资料,以手术方式不同分为改良组(58例)和常规组(42例),改良组予以改良大骨瓣开颅内外减压手术治疗,常规组予以常规开颅术治疗。两组患者均于术后6~12h行CT复查,比较两组患者中线移位恢复情况、术前及术后14d的颅内压及GCS评分以及神经元特异性烯醇化酶(NES)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平,术后进行为期9个月的随访,比较两组并发症的发生情况及预后情况。结果CT复查结果显示,改良组的中线移位恢复患者明显多于常规组(P<0.05);改良组的颅内压显著低于常规组,GCS评分显著高于常规组(P<0.05);改良组的NES、TNF-α及IL-6均显著低于常规组(P<0.05);两组并发症发生率比较无显著差异(P>0.05);改良组恢复良好或中残的例数明显高于常规组(P<0.05)。结论急性颅脑创伤运用改良大骨瓣开颅内外减压手术治疗效果更加显著,可有效降低颅内压并改善预后。
Objective To explore the effect of modified large bone flap and internal and external decompression surgery in the treatment of acute craniocerebral trauma.Methods The clinical data of 100 patients with acute craniocerebral trauma admitted to our hospital from January 2016 to January 2018 were retrospectively analyzed.According to different surgical methods,they were divided into modified group(58 cases)and conventional group(42 cases).The modified group was treated with modified large bone flap and internal and external decompression surgery,and the conventional group was treated with conventional craniotomy.The patients in both groups were given CT reexamination at 6-12 h postoperatively.The median shift recovery,intracranial pressure and GCS scores before and 14 days after surgery,and neuron-specific enolase(NES),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)levels were compared between the two groups.A 9-month follow-up was performed postoperatively to compare the incidence of complications and prognosis of the two groups.Results The CT review showed that in the modified group,the patients with midline shift recovery were significantly more than that in the conventional group(P<0.05);the intracranial pressure of the modified group was significantly lower than that of the conventional group,and the GCS score was significantly higher than that of the conventional group(P<0.05);The NES,TNF-αand IL-6 levels in the modified group were significantly lower than those in the conventional group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).The number of cases with good recovery or moderate disability in the modified group was significantly higher than that of the conventional group(P<0.05).Conclusion The treatment effect of acute craniocerebral trauma with modified large bone flap and internal and external decompression surgery is more significant,which effectively reduces intracranial pressure and improves prognosis.
作者
张永安
徐建平
陈旭
龚绍慧
余斌
熊成英
詹剑
ZHANG Yong-an;XU Jianping;CHEN Xu;GONG Shaohui;YU Bin;XIONG Chengying;ZHAN Jian(Department of Neurosurgery,Shangrao People's Hospital in Jiangxi Province,Shangrao 334000,China)
出处
《中国现代医生》
2019年第13期38-41,共4页
China Modern Doctor
关键词
改良大骨瓣开颅内外减压手术
急性颅脑损伤
常规开颅手术
神经元特异性烯醇化酶
Modified large bone flap and internal and external decompression surgery
Acute craniocerebral injury
Conventional craniotomy
Neuron-specific enolase
