颅脑外伤标准大骨瓣开颅术治疗急性硬膜下血肿的临床观察

目的 探讨标准大骨瓣开颅术(SLTC)治疗颅脑外伤急性硬膜下血肿的临床效果.方法 235例急性硬膜下血肿患者随机分为治疗组和对照组,治疗组给予SLTC治疗,对照组给予常规骨瓣开颅术治疗.观察迟发性血肿、急性脑膨出和切口脑脊液漏等并发症发生情况,记录术后1d、3d、7d颅内压情况,术后随访6个月评价临床疗效.结果 治疗组迟发性血肿、急性脑膨出和切口脑脊液漏发生率分别为15.8％、20.8％和20.0％,显著低于对照组(x2=7.107、3.843、8.389,P＜ 0.05).术后1、3、7d治疗组颅内压显著低于对照组(t=9.175、9.916、10.093,P＜ 0.05).治疗组临床疗效有效率为56.7％,对照组临床疗效有效率为43.5％,两组比较差异有统计学意义(x2=3.243,P＜ 0.05).治疗组重残和植物状态发生率为35.0％,死亡率为8.3％,显著低于照组(x2=3.215、3.375,P＜ 0.05).结论 SLTC治疗急性硬膜下血肿是一种安全、有效的治疗方法,值得临床应用.

Clinical observation of standard large trauma craniotomy for treating the patients with acute subdural hematoma

OBJECTIVE To investigate the clinical effects of standard large trauma craniotomy(SLTC) for treating the patients with acute subdural hematoma(ASH).METHODS 235 cases of patients with ASH were randomly divided into treatment group and control group,the treatment group was given the surgery of SLTC,and the control group was given the surgery of conventional craniotomy,the delayed hematoma,acute brain swelling and incision leakage of cerebrospinal fluid were observed,the intracranial pressure in postoperative 1 d,3 d,7 d was recorded,followed up 6 months to evaluate the clinical efficacy.RESULTS The incidence of delayed hematoma,acute brain swelling and incision leakage of cerebrospinal fluid of the treatment group were 15.8%,20.8% and 20.0%,the treatment group was significantly lower than control group(χ2 = 7.107,3.843,8.389,P﹤0.05);The intracranial pressure of the treatment group in postoperative 1 d,3 d,7 d was significantly lower than the control group(t = 9.175,9.916,10.093,P﹤0.05);The clinical efficacy of the treatment group was 56.7%,the control group was 43.5%,the treatment group was significantly higher than control group(χ2 = 3.243,P﹤0.05);The rate of severe disability and vegetative state of the treatment group was 35.0%,the mortality rate was 8.3%,the treatment group was significantly lower than control group(χ2 = 3.215,3.375,P﹤0.05).CONCLUSION The surgery of SLTC is safe and effective.The surgery of SLTC is worthy of clinical application.