经额颞顶枕超大骨瓣治疗重型颅脑损伤疗效分析

目的探讨经额颞顶枕超大骨瓣减压联合血肿清除术治疗重型颅脑损伤的临床价值。方法选取2009-01—2013-07我科收治的重型颅脑损伤患者114例,根据治疗方法不同分为2组,观察组64例行经额颞顶枕超大骨瓣手术治疗,对照组50例行标准大骨瓣手术治疗。结果 2组治疗后GCS评分均较治疗前明显提高,观察组改善更为显著。术后随访3个月,观察组患者恢复良好率、轻残率显著高于对照组,重残率与病死率比对照组显著降低。结论经额颞顶枕超大骨瓣治疗重型颅脑损伤,能够耐受麻醉,提倡尽早、积极手术,能够明显改善患者术后GCS评分,改善患者预后,降低重残率与病死率,具有较高临床应用价值。     

标准大骨瓣减压术治疗额颞部重型颅脑损伤

目的 评价标准大骨瓣减压手术治疗额颞重型颅脑损伤的疗效.方法 对额颞部重型颅脑损伤患者106例,采用标准大骨瓣开颅减压手术治疗58例,常规骨瓣开颅减压48例.结果 标准大骨瓣减压手术组58例中恢复良好29例,中残9例,重残2例,植物生存2例,死亡6例;常规骨瓣减压手术治疗48例中恢复良好14例,中残5例,重残3例,植物生存2例,死亡24例.分析比较2组恢复良好率和病死率均有显著性差异(P＜0.05).结论 标准大骨瓣减压手术,是治疗以额颞部重型颅脑损伤病人一种有效手术方式.能明显改善额颞部重型颅脑损伤病人的预后并降低病死率.     

经耳后超大骨瓣开颅手术治疗重型颅脑损伤

重型颅脑损伤并发脑疝是颅脑损伤患者死亡的主要原因,病死率可高达40％[1],因此如何快速有效地降低重型颅脑损伤患者的颅内高压是其治疗的关键[2].标准大骨瓣开颅手术的应用,较好的处理了一侧额颞顶部的颅内病变,充分减压,治疗重型颅脑损伤取得了较多的经验.但在实际应用中仍会遇到一些特殊情况,本科自2010年1月至2011年11月常规标准大骨瓣开颅手术救治重型颅脑损伤的同时采用经耳后枕顶额部超大骨瓣开颅手术治疗颅脑损伤患者13例,收到一定的效果,体会如下. 一、对象与方法 1.一般资料:本组13例,男11例、女2例,年龄20～78岁,平均47.7岁,受伤至入院时间1～7 h,平均3h,致伤原因:车祸伤4例、坠落伤9例. 2.临床表现:全部患者均为重型颅脑损伤,入院时GCS≤8分,3～4分4例,5～6分4例,7～8分5例,单侧瞳孔散大6例,双侧瞳孔散大3例.     

早期应用双侧额颞顶部超大骨瓣减压术治疗重型颅脑损伤的效果分析

目的探讨早期应用双侧超大骨瓣减压术治疗重型颅脑损伤的效果。方法对51例早期行双侧超大骨瓣减压术治疗的重型颅脑损伤患者临床资料进行回顾性分析。结果术后1年随访,采用GOS预后评分评估51例患者,其中GOS1分8例,GOS2分6例,GOS3分9例,GOS4分11例,GOS5分17例。结论早期应用双侧额颞顶部超大骨瓣减压术治疗重型颅脑损伤尤为重要,能有效降低死亡率和改善预后,值得临床推广应用。     

标准外伤大骨瓣开颅减压术治疗额颞部重型颅脑损伤对照研究

目的对比标准外伤大骨瓣开颅减压术与常规骨瓣开颅术治疗额颞部重型颅脑损伤的效果。方法 2014-01—2016-01在我院治疗的102例额颞部重型颅脑损伤患者随机分为实验组和对照组各51例,实验组患者应用标准外伤大骨瓣开颅减压术治疗,对照组患者给予常规骨瓣开颅术治疗,观察2组治疗效果和并发症发生率。结果实验组治疗效果良好率41.18%(21/51),病死率7.84%(4/51),并发症发生率15.69%(8/51),显著优于对照组的21.57%、23.53%和50.98%,差异有统计学意义(P0.05)。结论针对额颞部重型颅脑损伤患者采用标准外伤大骨瓣开颅减压术可提高治疗效果,降低并发症发生率和病死率,从而显著改善了患者的预后,值得临床推广。     

大骨瓣减压与常规骨瓣减压治疗重度颅脑损伤临床对照研究

目的比较大骨瓣减压与常规骨瓣减压治疗重度颅脑损伤的临床效果。方法总结我科2000-2004年间颅脑外伤病例符合重度颅脑损伤的97例,分两组,一组是大骨瓣(n=47)行单侧或双侧额颞顶骨瓣(12×14cm),另一组为常规骨瓣(n=50)颞顶瓣、额颞瓣、额瓣(6×8cm)开颅术。结果按伤后6个月随访预后结果(6-GOS)大骨瓣组:恢复良好20例,中残14例、重残6例、植物生存4例、死亡3例。常规骨瓣组:良好12例、中残10例、重残12例、植物生存8例、死亡8例(P<0．01)。大骨瓣减压组颅内压下降程度优于常规骨瓣组P<0．01。两组患者的术后并发症切口脑脊液漏、外伤性癫痫,颅内感染,外伤性脑积水(P>0．05),无显著性差异。结论大骨瓣减压治疗重度颅脑损伤的预后优于常规骨瓣组。     

双侧额颞去骨瓣减压治疗广泛性脑挫裂伤并发脑疝的21例体会

目的探讨双侧额颞去骨瓣减压治疗广泛性脑挫裂伤并发脑疝的疗效及手术指征。方法对21例行双侧额颞去骨瓣减压治疗的广泛性脑挫裂伤伴脑疝病例进行回顾性分析。结果根据GOS评分,恢复良好4例,轻残7例,重残4例,植物生存2例,死亡4例。结论双侧额颞去骨瓣减压能有效提高广泛性脑挫裂伤并发脑疝的重型颅脑损伤患者治疗效果。     

自体颅骨帽状腱膜下保存及回植

我院自 2 0 0 0年以来对颅内压增高需去骨瓣减压患者采用自体颅骨带蒂转移至帽状腱膜下保存 ,待颅高压消退后再将保存颅骨回植于原骨窗 ,达到颅骨成型满意效果。现报告如下 :资料与方法　　 1 .临床资料 :本组 3 0例 ,男 1 9例 ,女 1 1例。年龄在 1 9～ 71岁。颅脑损伤 2 3例 ,自发性脑内血肿 5例 ,高血压脑出血 2例 ;去骨瓣左额颞 1 0例 ,右额颞 8例 ,左颞顶 5例 ,右颞顶 5例 ,左颞顶枕 2例。颅骨瓣面积 4cm× 5cm～ 7cm× 8cm ,骨瓣回植时间 3 0～ 95d。2.手术方法 :在开颅去骨瓣减压术中 ,选择适合埋藏颅骨的帽状腱膜下间隙 ,用锐性分离…     

标准外伤大骨瓣开颅术治疗额颞顶广泛对冲伤疗效分析

枕顶部着力所致的额颞顶对冲伤是最常见的一种颅脑损伤,多表现一侧为主的额颞顶广泛脑挫裂伤合并颅内血肿,易早期形成脑疝,死亡率高。手术治疗具有极为关键的作用。笔者近三年来采用标准外伤大骨瓣开颅,扩大硬膜腔减张缝合术治疗单侧为主重型额颞顶对冲伤76例,与常规骨瓣治疗类似对冲伤84例相比,疗效较为满意。现分析如下。     

双侧额颞去骨瓣减压治疗弥漫性脑肿胀的护理

目的探讨双侧额颞去骨瓣减压治疗弥漫性脑肿胀的护理方法。方法对23例行双侧额颞去骨瓣减压治疗的重型颅脑损伤弥漫性脑肿胀患者的护理资料进行回顾性分析。结果按GOS评分,23例患者中恢复良好4例,轻残10例,重残3例,植物生存2例,死亡4例。结论对双侧额颞去骨瓣减压治疗弥漫性脑肿胀患者进行及时有效地护理,可提高其抢救成功率,获得良好的临床效果。     

Functional hemispherectomy for treatment of epilepsy associated with hemiplegia: rationale, indications, results, and comparison with callosotomy

Hemispherectomy is effective in arresting seizures associated with maximal or near maximal hemiparesis. This procedure, however, carries an unacceptable 33% risk of late complications due to cerebral hemosiderosis. Anatomically partial but functionally complete hemispherectomy was devised to avoid these complications. The frontal or occipital lobes, or both, were left in place with the blood supply intact but with connections to commissures and brainstem divided. The central strip and parietal and temporal lobes were removed. Twenty patients were so treated with a follow-up of 4 to 13 years (average, 7.3 years) in 14. Ten of these are seizure free, 1 had a single nocturnal seizure, 1 had occasional focal twitching, and 2 had a worthwhile but lesser reduction in the seizure tendency. None has developed cerebral hemosiderosis, to date. In appropriately selected patients, functional hemispherectomy is an effective procedure preferable to callosotomy or to partial hemispherectomy. When there is no independent ictal discharge from the opposite hemisphere, arrest of seizures may be expected, leading to improvement in cognitive functioning (mean increase, 10 IQ points), social behavior, and a reduction in or discontinuation of anticonvulsant medication. In these patients, gait and hand use remain unchanged.     

Behavioral, social, and affective factors associated with self-efficacy for self-management among people with epilepsy

The purpose of the study described in this article was to evaluate the extent to which selected behavioral, social, and affective factors contribute to self-reported epilepsy self-efficacy. Participants completed three assessments 3 months apart, with only those completing both the first and second assessments included in this analysis. Self-efficacy scores at the second assessment were regressed on the behavioral, social, and affective characteristics ascertained at the first assessment. The analysis revealed that self-management, depressive symptoms, and seizure severity explain the most variance in self-efficacy; patient satisfaction and stigma are less important predictors; and social support and regimen-specific support are not significant predictors. The results provide direction for identifying people with low levels of self-efficacy and highlighting areas that might help enhance self-efficacy in persons with epilepsy.     

Reduced Pseudoneglect for Physical Space,but not Mental Representations of Space,for Adults with Autistic Traits

Neurotypical individuals display a leftward attentional bias, called pseudoneglect, for physical space (e.g. landmark task) and mental representations of space (e.g. mental number line bisection). However, leftward bias is reduced in autistic individuals viewing faces, and neurotypical individuals with autistic traits viewing ‘greyscale’ stimuli, suggestive of atypical lateralization of attention in autism. We investigated whether representational pseudoneglect for individuals with autistic traits is similarly atypically lateralized by comparing biases on a greyscales, landmark, and mental number line task. We found that pseudoneglect was intact only on the representational measure, the mental number line task, suggesting that mechanisms for atypical lateralization of attention in individuals with autistic traits are specific artefacts of processing physically visual stimuli.     

Risk of,and risk factors for,vasculopathy associated with acute herpes zoster

ObjectivesWe aimed to summarize the known risk of vasculopathy (stroke, myocardial infarction [MI], and transient ischemic attack [TIA]) after herpes zoster (HZ) and the impact of antiviral treatment and vaccination against HZ on the risk of vasculopathy.Materials and methodsA narrative literature review was conducted in PubMed to identify evidence published in the past 15 years that was relevant to the scope of this article.ResultsTen studies reported that HZ was associated with an increased risk of stroke and one UK study reported no association. Four studies reported that HZ was associated with an increased risk of MI, and four reported that HZ was associated with an increased risk of TIA. Two studies reported that antiviral treatment was associated with a reduced risk of stroke and an additional two studies reported no association between antiviral treatment and the risk of stroke. In addition, two studies reported that vaccination against HZ using the live zoster vaccine (ZVL) was associated with a reduced risk of stroke, and an additional two studies reported that the risk of stroke or MI after HZ was similar between ZVL vaccinated and unvaccinated individuals.ConclusionsHZ is associated with an increased risk of stroke, MI, or TIA (strongest association is between HZ and stroke). Further studies are needed to determine whether antiviral treatment or ZVL vaccination influence the risk of HZ-associated vasculopathy. In addition, the effect of the recombinant zoster vaccine on the risk of HZ-associated vasculopathy should be studied.     

Feasibility of accelerometer technology with individuals with autism spectrum disorder referred for aggression,disruption, and self injury

BackgroundMost research on aggression, self-injury, and disruption in autism spectrum disorder (ASD) has relied on caregiver report or direct observation, both of which have limitations. Past studies demonstrate preliminary evidence for direct detection of these behaviors using accelerometers, but additional research is needed to determine the feasibility during actual clinical assessments and times when a therapist cannot be present for direct observation, as measurement during these periods has the most applied significance.AimsThis study addressed these gaps by evaluating the feasibility of accelerometer use with children with ASD and severe aggression, self-injury, and disruption in clinical and home contexts.Methods and ProceduresWe evaluated the feasibility of individuals with ASD wearing accelerometers during behavioral assessments following structured habituation procedures. We also evaluated the feasibility of caregivers applying sensors to individuals with ASD in the home setting.Outcomes and ResultsMost participants passed habituation and tolerated sensors during behavioral assessments (e.g., functional analyses). Caregivers applied sensors in the home with variable fidelity with wear time duration and data-collection.Conclusions and ImplicationsThe feasibility of using accelerometers with this population is promising and should be explored further in future research.